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Blood supply of the mammary gland
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Korenkov Topographic Anatomy (1)
| Blood supply of the mammary gland
(Fig. A.3) : 1) rr. mammarii mediales from rr. perforantes, from a. thoracica interna system; 2) rr. mammarii laterales from a. thoracica lateralis; 3) rr. perforantes from aa. intercostales. Venous drainage to superior vena cava system occurs through the homonymous veins. The lymph outflows from breast in different ways, what has a practical importance in metastastatic spread through these ways in cases of malignant growth (breast cancer) (Fig. A.5). The main direction of lymph drainage from breast is axillary path which begins with 2 – 3 vessels which flow along the inferior border as great vessels of pectoralis major muscle and flow into nodi lymphoidei pectorales (Sorgius nodes). These nodes are located along a. thoracica lateralis on the level of the 2nd – 4th ribs. They are the most frequent focuses of metastasis. From these nodes the lymph drains to axillary lymph nodes, nodi lymphoidei axillares centrales, and from nodi lymphoidei axillares centrales – to nodi lymphoidei axillares apicales which 14 are located along v. axillaris. From nodi lymphoidei axillares apicales the lymph drains to deep inferior cervix nodes or to subclavian trunk. The Troisier’s lymph node has a clinical relevance which is palpated in metastases above the clavicle beside outer edge of sternocleidomastoid muscle. From posterior part of mamma the lymphatic vessels go along transpectoral path upwards while passing through m. pectoralis major, go through nodi lymphoidei interpectorales Rotter’s lymph nodes and fascia clavipectorale, and fall into nodi lymphoidei axillares apicales or into deep cervix (subclavian) nodes. Moreover, the sternal path is important as well. It begins from medial sternal segments, goes through m. pectoralis major in intercostal spaces toward nodi lymphoidei parasternales which are located along internal sternal vessels. From nodi lymphoidei parasternales the lymph drains: ● from the left – into the left subclavian trunk and arch of thoracic duct; ● from the right – into the right subclavian trunk, right lymph duct or into nodi lymphoidei prepericardiaci. Nodi lymphoidei prepericardiaci have connections with tracheal and tracheal-bronchial nodes, as well as with bronchial-pulmonic and infrapulmonary nodes. Thus, metastasis of cancer from chest to lungs is possible. Along the intercostal lymph vessels, the intercostal lymph nodes anastomose with nodi lymphoidei intercostales and nodi lymphoidei prevertebrales. Thus, metastasis of cancer from chest to corpus vertebrae is possible as well. The lymph vessels of right and left mammae are connected together as by means of lymphatic reticulum of skin so anastomoses of presternal lymph nodes from both sides. The metastases of cancerous growths can effuse from 15 presternal lymph nodes along a. epigastrica superior et inferior into anteperitoneal cellular tissue, perineal lymph nodes, and abdominal cavity and gonads, and along ligamentum teres hepatis – into liver. жүктеу/скачать 2,76 Mb. Достарыңызбен бөлісу:
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