Lymphology Association of North America (LANA) Practice Exam

What anastomoses pathways should be used during MLD for a patient with left, lower-extremity lymphedema and a history of left inguinal lymph-node dissection?

1. Right inguinal-axillary and interinguinal

2. Interinguinal only

3. Bilateral inguinal-axillary and interinguinal

4. Left inguinal-axillary and interinguinal

The correct answer is: Left inguinal-axillary and interinguinal

The choice of pathways for manual lymph drainage (MLD) in a patient with left lower-extremity lymphedema and a history of left inguinal lymph-node dissection is crucial for effective treatment. In this scenario, utilizing the left inguinal-axillary and interinguinal anastomoses is appropriate because these routes provide the most direct way to facilitate lymphatic drainage from the affected area. The left inguinal-axillary pathway allows for the movement of lymph from the left leg, which is experiencing lymphedema, to the axillary region. This is particularly important when the primary lymphatic drainage route has been compromised due to the surgical removal of lymph nodes in the left inguinal region. The interinguinal anastomoses, which connect the left and right inguinal regions, can also help to reroute lymph flow in a way that compensates for the disrupted lymphatic system on the left side. By focusing on these pathways, the treatment aims to lessen the fluid accumulation in the left lower extremity and promote better lymphatic drainage, enhancing patient outcomes. In cases of lymphedema, it's essential to use the pathways that provide the best alternative routes for lymph to