Dear Jane = LWO Member Questions

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How does a healthy lymphatic system work?
Wow, this is a big question but if you are talking about the mechanics of the ‘lymphatic system’ and how it moves, we can narrow it down. Firstly though, it is important to understand that the lymphatic system is responsible for two things; fighting infection and draining lymph. In fighting infection it regulates inflammation and produces cells to fight infection. Sometimes it overcompensates and produces too many cells and this causes inflammation, which can go on to cause skin thickening and skin changes. This puts the skin and body at increased risk of cellulitis and infection.

The lymphatic system is responsible for draining all fluid away from the skin, so any that leaves the blood circulation can only be removed by the lymphatics, or through a lymph node back into the veins. The lymphatics start in the skin- the top layer of the skin. They are what we call initial lymphatics or lymphatic capillaries and are empty until they are moved and stretched to encourage fluid in. They sit in the skin connected to collagen fibres, which open and close the initial lymphatics, in response to movement, sucking in the lymph. The initial lymphatics are connected to tubes which are vertical to the skin, taking fluid down, then connect to bigger tubes (horizontal in the skin), which have the first small muscle cells in the wall. Within these bigger tubes, known as ‘lymphatic collectors’, are valves. These are responsible for contracting and propelling lymph along. Some people who have primary lymphoedema, don’t have the muscle cells, or the valves, meaning that the lymph cannot be propelled along the tubes.

When the initial lymphatics in the skin have stretched enough, they will push the fluid down and into the pre-collector and collector vessels (or tubes). Once the collector in full enough, it will transfer the fluid along. If it doesn’t get full, the fluid will not be pushed along. It increases about 300 times its size to push the lymph along. On its journey, the lymph will meet a lymph node. Nodes will filter the lymph, fight any infection and then it will go on its journey. As the lymph enters the node, the node will increase and force some fluid (mainly water) into the blood vessel within the node, returning it back to the blood circulatory system and the heart for it to recirculate.

- Schematic diagram of the lymphatic system. (Reproduced with the permission of Hiroo Suami).

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