Original Author: Stuart Jones

Last Updated: December 22, 2017

LYMPHATIC DRAINAGE OF THE LOWER LIMB Revisions: 35

Contents

1 Lymphatic Vessels
1.1 Superficial Lymphatic Vessels
1.2 Deep Lymphatic Vessels
2 Lymphatic Nodes
2.1 Inguinal Nodes
2.2 Popliteal Nodes
3 Clinical Relevance: Lymphadenopathy

The lymphatic system functions to drain tissue fluid, plasma proteins and other cellular
debris back into the blood stream, and is also involved in immune defence. Once this
collection of substances enters the lymphatic vessels it is known as lymph; lymph is
subsequently filtered by lymph nodes and directed into the venous system.

This article will explore the anatomy of lymphatic drainage throughout the lower limb,
and how this is relevant clinically.

Lymphatic Vessels
The lymphatic vessels of the lower limb can be divided into two major groups; superficial
vessels and deep vessels. Their distribution is similar to the veins of the lower limb.

Superficial Lymphatic Vessels

The superficial vessels can be divided into two major subsets; (i) medial vessels, which
closely follow the course of the great saphenous vein and; (ii) lateral vessels which are
more closely associated with the small saphenous vein.

Medial Vessels
The medial group originate on the dorsal surface of the foot. They travel up the anterior
and posterior aspects of the medial lower leg, with the great saphenous vein, passing
with it behind the medial condyle of the femur. This group of vessels ends in the groin,
draining into the sub inguinal group of the inguinal lymph nodes.

Lateral Vessels

The lateral vessels arise from the lateral surface of the foot and either accompany the
small saphenous vein to enter the popliteal nodes, or ascend in front of the leg and
cross just below the knee joint to join the medial group.

Deep Lymphatic Vessels

These are far fewer in number than their superficial counterparts and accompany the
deep arteries of the lower leg. They are found in 3 main groups: anterior tibial,
posterior tibial and peroneal following the corresponding artery respectively, and
entering the popliteal lymph nodes.

Lymphatic Nodes

Inguinal Nodes
The inguinal nodes are found in the upper aspect of the
femoral triangle and are 1—20 in number.

They are subdivided into 2 groupings determined by their

position relative to a horizontal line drawn at the level of
termination of the great saphenous vein. Those below this
line are the sub-inguinal nodes (consisting of a deep and
superficial set) and those above are the superficial
inguinal nodes.

Superficial Inguinal Nodes

These form a line directly below the inguinal ligament and

receive lymph from the penis, scrotum, perineum, buttock
and abdominal wall.

Superficial Sub-Inguinal Nodes

These are located on each side of the proximal section of

the great saphenous vein. They receive afferent input
primarily from the superficial lymphatic vessels of the lower
leg.
Deep Sub-Inguinal Nodes

These are often found in one to three in number and are

most commonly found on the medial aspect of the femoral
vein. The afferent supply to these nodes is from the deep
lymphatic trunks of the thigh which accompany the femoral
vessels.

Popliteal Nodes
The popliteal lymphatic nodes are small in size, usually
between five and seven in number, and are often found
imbedded in fat reserves in the popliteal fossa. They
receive lymph from the lateral superficial vessels.

The efferent vessels of the popliteal nodes pass almost

entirely alongside the femoral vessels to empty into the
deep inguinal nodes. However, some will accompany the
great saphenous vein and drain into the sub-inguinal
nodes.

Fig 1 – The superficial and sub-

inguinal lymph nodes.

Clinical Relevance: Lymphadenopathy

Lymphadenopathy is characterised by an abnormality in size, number or
consistency of any lymphatic nodes within the body. This is usually in response to
infection, malignancy or an auto-immune condition.

Abnormality of the inguinal vessels should always be viewed suspiciously. The

superficial inguinal nodes receive drainage from the penis, scrotum, buttocks
and abdominal wall as far as the umbilicus. Suspicion of lower limb
lymphadenopathy therefore should include a full examination of both the lower limb
and these structures.

In males, the testicles follow a different lymphatic route, and drain directly to the
para-aortic nodes and therefore will rarely cause inguinal lymph node enlargement.
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