Dermal lymphatics
Reticular dermis · Sentinel node Lymphoedema No epidermal lymphatics
Blind-ended initial lymphatics beginning in the papillary dermis and draining into a deeper dermal and subcutaneous plexus. They clear interstitial fluid and protein and carry antigen-loaded dendritic cells to the regional node.
Traced from the start
Detail
- Origin
- Blind-ended, valveless initial lymphatics in the papillary dermis; the epidermis itself has none
- Function
- Return interstitial protein and fluid, and provide the migration route for Langerhans and dermal dendritic cells to the draining lymph node
- Surgical relevance
- Cutaneous lymphatic drainage is predictable enough that lymphoscintigraphy plus blue dye identifies the sentinel node in melanoma and breast cancer
When it goes wrong
Streptococcal cellulitis or erysipelas scarring the dermal lymphatics
Impaired drainage predisposes to further attacks, setting up a cycle of recurrent cellulitis and progressive lymphoedema that may need long-term prophylactic penicillin
Chronic lymphoedema of any cause
Non-pitting swelling with a positive Stemmer sign, skin thickening, and a small long-term risk of lymphangiosarcoma; management is compression and skin care, not diuretics
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