Fuse Yuma, Fanning James E, Boyd Travis, Singhal Meera, Bohnen Jordan, Raduan Fernando, Singhal Dhruv
From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Department of Plastic Surgery, University of Texas Southwestern, Dallas, TX.
Plast Reconstr Surg Glob Open. 2025 May 5;13(5):e6791. doi: 10.1097/GOX.0000000000006791. eCollection 2025 May.
Vascularized lymph node transplant (VLNT) is widely performed for chronic upper and lower extremity lymphedema. However, ideal recipient sites for the transplant are still under debate. The placement of VLNTs distally in an extremity can be challenging as the small cross-sectional area of the limb at this level does not allow for flap inset without gross contour deformity, which can adversely impact aesthetic outcomes and preclude fitting of an adequate compression garment. In this article, we introduce the Kager triangle as a potential distal lower extremity VLNT recipient site for the lower extremity. The Kager triangle is bordered by the Achilles tendon, the flexor hallucis longus, and the calcaneus, which accommodates the Kager fat pad, the largest adipose structure in the lower extremity. We transferred an omentum lymph node flap to the Kager triangle, and the posterior tibial artery and the anterior lateral malleolar artery were utilized as recipient vessels in a flow-through fashion. The incisions were directly closed with excellent cosmesis.
血管化淋巴结移植（VLNT）广泛应用于慢性上肢和下肢淋巴水肿的治疗。然而，该移植的理想受体部位仍存在争议。将VLNT置于肢体远端可能具有挑战性，因为该水平肢体的小横截面积不允许皮瓣嵌入而不产生明显的外形畸形，这可能对美学效果产生不利影响，并妨碍穿戴合适的加压衣。在本文中，我们介绍了Kager三角作为下肢潜在的远端下肢VLNT受体部位。Kager三角由跟腱、拇长屈肌和跟骨界定，其中容纳了Kager脂肪垫，这是下肢最大的脂肪结构。我们将大网膜淋巴结皮瓣转移至Kager三角，并采用顺行血流方式将胫后动脉和腓骨前外侧动脉用作受体血管。切口直接缝合，美容效果极佳。
