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Lymphatic anatomy: lymphatics of the vulva
Published in Charles F. Levenback, Ate G.J. van der Zee, Robert L. Coleman, Clinical Lymphatic Mapping in Gynecologic Cancers, 2022
Anca Chelariu-Raicu, Robert L. Coleman
In the cross-section in Figure 3.6c, the patient is very thin, as there is almost no fat between the skin and Camper’s fascia. This figure shows the superficial nodes very close to the skin. In other patients, the ‘superficial’ inguinal nodes can be very ‘deep’ to the skin due to a thick layer of subcutaneous fat. This overlooked observation contributed to the poor results observed with external beam radiation therapy by the Gynecologic Oncology Group.23 The cribriform fascia is depicted as a bold black line separating the superficial and femoral nodes. As described earlier, this structure is more appropriately described as a lamina.
Venous disorders
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Closure of the cribriform fascia, with sutures or synthetic patches over the ligated SFJ, does not reduce groin recurrence. Stripping to the lowest point of reflux may improve results, but at a cost of increased saphenous nerve complications and is not widely performed. More recently, some surgeons argue that surgical trauma and subsequent inflammation in the groin is associated with neovascularisation, which in turn may lead to recurrence. Furthermore, others hypothesise that it is the loss of the normal groin tributaries that may be responsible for driving the process of neovascularisation. These concepts have led some to believe that ligation of the refluxing vein should be distal to the tributaries and that the junction itself should be left untouched. There is no clear clinical evidence to support these hypotheses.
Surgery for lower limb varicose disease
Published in Ken Myers, Paul Hannah, Marcus Cremonese, Lourens Bester, Phil Bekhor, Attilio Cavezzi, Marianne de Maeseneer, Greg Goodman, David Jenkins, Herman Lee, Adrian Lim, David Mitchell, Nick Morrison, Andrew Nicolaides, Hugo Partsch, Tony Penington, Neil Piller, Stefania Roberts, Greg Seeley, Paul Thibault, Steve Yelland, Manual of Venous and Lymphatic Diseases, 2017
Ken Myers, Paul Hannah, Marcus Cremonese, Lourens Bester, Phil Bekhor, Attilio Cavezzi, Marianne de Maeseneer, Greg Goodman, David Jenkins, Herman Lee, Adrian Lim, David Mitchell, Nick Morrison, Andrew Nicolaides, Hugo Partsch, Tony Penington, Neil Piller, Stefania Roberts, Greg Seeley, Paul Thibault, Steve Yelland
A prosthetic or anatomical physical barrier can be interposed between the ligated stump and adjacent superficial veins to prevent neovascular veins from developing. A polytetrafluoroethylene (PTFE) patch proved to be an effective barrier at mid-term. Closure of the cribriform fascia and interposition of a silicone patch have also been successful in reducing recurrence rates, although some complications have been reported directly related to the silicone patch.3 A more complex barrier technique is to use a flap of pectineus fascia. Disadvantages are an increased risk of infection and subsequent scarring.
Sentinel lymph node biopsy based on anatomical landmarks and locoregional mapping of inguinofemoral sentinel lymph nodes in women with vulval cancer: an operative technique
Published in Journal of Obstetrics and Gynaecology, 2023
Fong Lien Kwong, Miski Scerif, Jason KW Yap
Data from women who underwent unilateral or bilateral groin SLN biospies from 1 February 2020 to 15 October 2022 at a single regional cancer centre were prospectively collected. Our centre introduced inguinofemoral SLN biopsies for vulval cancer over 15 years ago and receives referrals from other Cancer Centres across the West Midlands, UK. All subjects met the GROINSS-V eligibility criteria (unifocal tumour, SCC of vulva, the width of tumour not exceeding 4 cm, depth of invasion over 1 mm and no clinically or radiologically suspected nodal involvement). Women with unresectable tumours measuring over 4 cm, multifocal lesions, enlarged or suspicious lymph nodes or in whom a nodal biopsy had previously confirmed the presence of nodal involvement, suspected disseminated disease on imaging (e.g., pulmonary or skeletal metastasis) and those who were pregnant at the time of the study were excluded. All women provided written consent for the procedure as per the Trust protocol. The location of superficial SLN was described relative to the long saphenous vein as ‘above and medial’, ‘above and lateral’ or ‘above saphenous vein’. Cloquet’s node was defined as the deep node medial to the saphenous vein and beneath the cribriform fascia. All women were followed 2-monthly for two years and then 4-monthly for a further three years.