Points of highest concentration of lymph nodes
(Elbows, knees and along the collar are slightly less).
The arrows show the direction of lymph flow.
The deep lymphatics meet the anterior tibial lymph nodes along their path, situated in the higher,
anterior part of the leg, and the lymph nodes of the popliteal cavity (4-5 in number), situated on the
posterior face of the knee. They then reach the deep inguinal lymph nodes that are located deep in
the inguinal area.
In addition to the superficial lymph vessels of the lower limb, the surface inguinal lymph nodes (18-
20 in number) collect the lymphatics of the buttocks, perineum, the anus, the external genital organs,
and lower part of the abdomen. In addition to the deep popliteal lymphatic vessels, the deep inguinal
lymph nodes (2-3 in number) mostly collect what comes from the surface inguinal lymph nodes.
The largest of these lymph nodes is called the Cloquet lymph node and is located higher up and
deeper down than the others, extruding therefore into the abdominal cavity. Main Groups of lymph
nodes of the lower limbs
2.1.1 Main groups of lymph nodes of the lower limbs
These lymph node centers of the lower limbs are very important in the functioning of the whole
system, as they act as collection tanks, and also purify the lymph coming from the lower limbs. The
lymph stays in these centers as long as necessary to be filtered, i.e. purified, and is then poured
back into the renal system with increase of diuresis. This increase of the diuresis is often
encountered after therapy with pressure systems (massage pressure therapy) and confirms
activation of the lymphatic system mechanisms in the lower limb tissues.
2.1.2 General Concepts of lymphatic circulation Casley-Smith Pump
Lymphatic circulation is not just a system that intervenes in cases of “over fullness” but also permits
the rapid absorption of proteins and colloids.
Thanks to the lymphatic system, large or insoluble plasmatic protein molecules that cannot normally
be reabsorbed by the venous system are reintroduced into the blood circulation.
The molecules pass the capillary membrane in a manner that is inversely proportional to their
weight: the amount of albumin is higher in lymph, which has a lower molecular weight than globulin.
Of course variations of the capillary permeability caused by increase in intercapillary hydrostatic
pressure or toxic-anoxic factors for example, mean that there is an increase in that transfer, in a
modification of the lymph flow or its composition.
For further clarification, we provide Rossing’s findings on the matter:
1. the intravascular masses of albumin and immunoglobulin depend on the amount of synthesis
and the amount of fractionated catabolism;
2. The ratios of intravascular masses to the total masses depend on the amount of
transcapillary escape and on the amount of extravascular return;
3. the amount of transcapillary escapes are inversely related to the molecular weights of the
proteins; the amount of transcapillary escape increases with the filtration pressure in the
vessels, i.e. with the loss at micro vessel level, as seen in diabetes mellitus;
4. the amount of extravascular return reflects the lymphatic protein transport and is inverse to
the extravascular transit time. It is of the same magnitude for albumin, lg.G, and perhaps a
bit less for lg.M;
5. the extravascular transit time includes a wide series of transit times: short (liver, kidneys,
lungs), long (skin, muscles, with maximum deposit of extravascular proteins);
6. in most cases of hypoproteinemia, the amount of intravascular/extravascular plasmatic
protein distribution changes in favor of the intravascular space;
7. the extravascular pathological build-up of plasmatic protein occurs in a few diseases, and
when the transcapillary escape increases without a corresponding increase in the amount of
lymphatic return. This can be seen in cirrhosis with ascites, in untreated myxedema and in
some types of cancer, particularly those with hepatopathy and ascites. If anything, the
extravascular build-up of plasmatic protein will occur in the tumoral and post-operative tissue
in the wounds.