LYMPH-VESSELS OF THE LOWER LIMB 



721 



(6) The posterior pectoral group [Igl. pectorales] consists of small nodes situated on the inner 

 wall of the axilla, along the course of the long thoracic artery. They receive afferents from 

 the lateral integument of the thorax and drain into the nodes of the central group. 



2. THE LYMPHATIC VESSELS OF THE UPPER EXTREMITY 



The lymphatic vessels of the upper extremity are divided into two sets — a 

 superficial and a deep set. 



The superficial vessels. — The superficial lymphatic vessels of the arm course 

 in two layers, the one quite subcutaneous, the other next the deep fascia, with 

 frequent anastomoses between the two sets. The majority of these vessels 

 remain superficial throughout the arm, but some of them pass through the deep 

 fascia in the upper arm especially where the basilic vein pierces the deep fascia, 



Fig. 566. — The Axillary Lymph-nodes. (After Poirier and Cuneo.) 

 Brachial group Central group 



Delto-pectoral 

 node 



Nodes connect- 

 ing the central 

 and subscapu- 

 lar groups 

 Subscapular 

 group 



Anterior pec- 

 toral chain 



Anterior pec- 

 toral chain 



.,^., Subclavian 



XN group 



..Vessel from the 



mammary 

 gland 



Anterior pec- 



- toral node 

 Vessel from the 



mammary 

 gland 



Collecting trunk 

 Subareolar 



plexus 

 Vessel from 



- lateral 

 thoracic wall 



-Vessel passing 

 to internal 

 mammary 



, node 

 Collecting 



vessels 

 Vessel passing 

 to internal 

 mammary 

 node 



to join the deep lymphatics accompanying the brachial artery. The general 

 distribution of the superficial lymphatics and their relations with the lymph- 

 nodes are shown in figs. 565 and 567. 



The capiUary plexus is most dense in the palmar surfaces of the fingers, where the meshes 

 are so fine that they can only be seen with a lens. On the dorsal surface of the fingers and hand 

 the plexus is less dense. From the plexus on the palmar side of the fingers vessels come together 

 at the base of the fingers where they pass dorsally to be joined by the dorsal vessels of the 

 finger. They now foUow two rather distinct curves: (1) those from the thumb and index 

 finger and a part of the middle finger pass upward along the radial side of the forearm, course 

 medially over the lower part of the biceps muscle, and empty into the axillary lymph-nodes. 

 One or two vessels follow the cephalic vein and, after traversing the delto-pectoral node, pierce 

 the costo-coracoid membrane to enter the subclavian nodes, or pass over the clavicle into the 

 inferior deep cervical nodes. (2) Those from the rest of the fingers course for a short stretch 

 on the dorsum of the forearm, when they turn toward the ulnar side, wind around to the volar 

 side and either continue superficially along the upper arm to the axillary nodes, or pass into 

 the superficial cubital node, or, joining the efferents from these nodes, pass through the deep 

 fascia to unite with the deep lymphatics. (3) A set of vessels from the palm of the hand passes 

 upward along the volar side of the forearm. Anastomoses are frequent between these groups of 

 lymphatic vessels, particularly in the cubital region. 



It will thus be seen that the superficial cubital nodes receive lymph from the ulnar digits 

 and from the palm of the hand, but not from the thumb and forefinger. 



The superficial lymphatics from the rest of the arm join these three main groups at various 

 levels. 



The deep vessels. — -The deep lymphatic vessels of the upper extremity drain 

 the joint capsules, periosteum, tendons, and (if the recent work of Aagaard is 



46 



