LYMPHATICS OF LOWER EXTREMITY 667 



THE LY2IPHATICS OF THE LOWER EXTEEJIITY 



The lymphatics of the lower extremity, like those of the upper, may be 

 divided into the superficial and thedeej). The former run in the subcutaneous tissue 

 with the superficial veins, the latter along the course of the deep arteries. At the 

 groin the superficial end in the deep, which then pass under Poupart's ligament 

 into tlie abdomen. 



I. THE SUPERFICIAL LYMPHATIC VESSELS AND GLANDS OF 

 THE LOWER EXTREMITY 



The superficial lymphatic vessels follow in chief part the long and short 

 saphenous veins. Passing from the toes to a plexus on the dorsum and sole of the 

 foot respectively, they thence run up the leg, forming two chief sets of lymphatic 

 vessels, an inner and an outer. The inner and larger accompanies the long 

 saphenous vein in front of the ankle, l)ehind the inner side of the knee, and then up 

 the inner and front part of the thigh to the inguinal glands. The outer set, 

 beginning on the outer side of the foot, run up the outer side of the leg, some 

 passing round the front of the tibia to end in the inner set below the knee; others 

 passing over the popliteal space to join the inner set higher in the limb; and 

 others, again, perforating the deep fascia along with the short saphenous vein to 

 end in the popliteal glands. 



The lymphatics of the gluteal region wind, in part round the inner side of 

 the thigli, ovtn- the ujjper portion of the adductors, to join the innermost inguinal 

 glands; and in part over the crest of the ilium to join the outermost inguinal glands. 

 On this account it is not uncommon to find tliat an abrasion caused V»y wearing an 

 ill-fitting truss results in an abscess in tlie inguinal region. 



The superficial lymphatic glands. — There are no superficial glands below 

 the inguinal. 



The inguinal glands, six to twelve in number, are situated in the inguinal 

 region. They may be subdivided into the oblique, or inguinal projaer, Avhicli are 

 grouped along the course of Poupart's ligament; and the vertical, or femoral, or 

 saplienous, which surround the saphenous opening. 



The oblique or inguinal glands proper, which are situated on a higher level 

 than the vertical set, receive tlic lympliatics from the integuments of the penis and 

 scrotum, and the skin of the ]Uidenda and lower part of the vagina in the female. 

 They also receive the lymphatics from the integuments of the lower part of the 

 abdomen, and that covering the perinatal and gluteal regions. Their efferent vessels 

 in part pass through the saphenous opening, and in part perforate the deep fascia 

 to end in tlie deep inguinal and, to some extent, in the lumbar glands. It is these 

 superficial inguinal glands wliich become enlarged in venereal disease, in chancres 

 and epithelioma of the penis and scrotum, or labia in the female, and in boils or 

 other sources of irritation about the anus, gluteal region, and ]>erin.Tum. 



The vertical set, or saphenous or superficial femoral glands, receive the 

 superficial lymi)hatics from the lower limb. They are found enlarged in sores on 

 the heel, malignant disease of the skin, etc. 



II. THE DEEP LYMPHATIC VESSELS AND GLANDS OF THE 

 LOWER EXTREMITY 



The deep lymphatic vessels of the lower limb follow the course of the deep 

 arteries and veins. Thus tliey accom])any tlie internal and external plantar arteries 

 in the sole, and the dorsalis pedis artery on tlie dorsum of the foot. In the leg 

 they are found following the posterior tibial, anterior tibial, and ])eroneal arteries, 

 and, after passing through the lymphatic glands in the popliteal space, accompany, 



