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. 2019 Jun 11;9:8499. doi: 10.1038/s41598-019-44735-w

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© The Author(s) 2019

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

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Association between the classification of dermal back flow type and lymph flow pathway in lymph node-negative cases of the affected limbs. (a) The superficial pathways seem to be inferior; dermal back flow appears in the distal site, similar to those cases in which lymph nodes around the clavicle were positive. It is remarkable that there were no superficial-dominant cases with a type I pattern of dermal back flow, whereas only four cases were classified into this group. At the same time, no cases (out of 13) were classified under the ‘superficial dominant’ type V group. (b) Type IV and V cases seem to be the most prevalent. In other words, in those cases with negative lymph nodes around the clavicle in the images, few mild cases were observed regardless of the lymph flow pathway. This is comparable with the findings of Fig. 2a.