THE LYMPH VESSELS OF THE SUPEEIOE EXTEEMITY. 1009 



anterior glands are derived from the anterior wall of the body above the um- 

 bilicus from the lateral two-thirds of the mamma. Their efferents pass to the 

 central, lateral, and infra-clavicular axillary glands (Fig. 806). 



(d) The central axillary lymph glands, 2-6, lie in the central part of the axilla, and 

 frequently along the line of the intercosto-brachial nerve. They receive afferents 

 from the anterior, the subscapular, and the lateral glands. Their efferents pass 

 to the infra-clavicular glands (Fig. 806). 



(e) The subpectoral group of axillary lymph glands, 3-14, is formed by several 

 small glands which lie posterior to the pectoralis minor and anterior or medial to the 

 axillary artery. They receive lymph from the glands situated at a lower level and 

 from the lateral wall of the thorax. Their efferents pass to the infra-clavicular 

 glands. 



(/) The infra-clavicular group of axillary lymph glands, 1-11, lies in the region 

 between the upper border of the pectoralis minor and the clavicle, along the medial 

 side of the axillary artery. The glands receive efferents from the arm, from the other 

 groups of axillary glands, and directly from the mamma and the pectoral muscles, 

 along the line of the pectoral branches of the thoraco-acromial artery, and from 

 the inter-pectoral glands. Their efferents pass to the inferior deep cervical glands 

 and to the subclaviau lymph trunk (Fig. 806). 



(#) A delto-pectoral lymph gland is occasionally found in the groove between the 

 deltoid and the pectoralis major muscles. It receives afferents from the superficial 

 parts of the arm and the shoulder, and gives efferents to the subclavian trunk and 

 to the infra-clavicular glands. 



(h) Small inter-pectoral lymph glands are sometimes found between the great and 

 small pectoral muscles. They are connected with the lymph vessels which pass 

 from the posterior part of the mamma to the infra-clavicular glands (Fig. 806). 



THE LYMPH VESSELS OF THE SUPEKIOR EXTEEMITY. 



The lymph vessels of the superior extremity, like the glands, form two groups (1) superficial, 

 and (2) deep. 



(1) The superficial lymph vessels lie in the skin and the subcutaneous tissues. They 

 commence in cutaneous plexuses, which are finest and most dense on the volar aspects of the 

 fingers and hand. The efferents from the volar digital plexus of each finger pass to the dorsum 

 of the digit. There they unite to form dorsal digital vessels, 2-4, which run to the dorsum 

 of the hand where they unite together to form new vessels. 



FIG. 808. SUPERFICIAL LYMPHATICS OF THE DIGITS AND OF THE DORSAL ASPECT OF THE HAND. 



The efferents from the volar plexus of the hand run proximally, distally, and to the lateral 

 and medial margins of the hand. The lateral efferents, as they turn round the lateral border 

 of the hand, join the efferents of the thumb. The medial efferents turn round the medial 

 border of the hand, and join the efferents of the little finger. The afferents which run 

 proximally are few and variable ; when they are prese.nt they lie along the line of the superficial 

 median vein of the forearm. The efferents which run distally pass to the interdigital clefts 

 where they turn dorsally and join the vessels on the dorsum of the hand (Figs. 807, 808). 



As the superficial lymphatics pass towards the elbow they tend to form two main streams 

 (1) a lateral stream which accompanies the cephalic vein, and (2) a medial stream which 

 accompanies the basilic vein. The lymph vessels which commence on the dorsum of the hand 

 and forearm converge to one or other of the two main groups of vessels. In the region of 



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