Collateral lymphatic circulation

The collateral lymphatic circulation is a very important clinical pathophysiological phenomenon. The presence of a collateral lymphatic circulation is a sign of an obstructed lymph outflow and depends on location of the obstruction and on developmental anatomy of the lymphatic system. Direct lymphography is the method of choice to study lymphatic pathways. The collateral lymphatic circulation was studied in patients with malignant metastatic lymph node involvement, in primary lymphomas, in filariasis, in protein losing enteropathy, and in patients with secondary postoperative and/or postirradiation therapy. The collateral lymphatic circulation demonstrated by direct lymphography shows various types of collaterals. We have divided them into the typical collaterals (cutaneous, subcutaneous, parietal, perivisceral) and atypical collaterals (lymphovenous communications, extravasation into cavities, internal lymphatic fistula). The various collaterals are described and demonstrated in this paper. Of special importance for surgeons and physiotherapists, are the cutaneous and subcutaneous collaterals crossing lymphoshed borders. The main goal for the surgeon is to recognize preoperatively not only lymphatic obstruction, but also existing lymphatic collateral pathways, and to try to preserve them.