The Kager Triangle: An Anatomic Review and Potential Implications for Lymphatic Surgery.

Area of Science:

• Microsurgery
• Plastic Surgery
• Lymphedema Management

Background:

• Vascularized lymph node transplant (VLNT) is a common treatment for chronic lymphedema.
• Optimal recipient sites for distal VLNTs remain debated due to challenges with limb contour and compression garment fitting.

Purpose of the Study:

• To introduce the Kager triangle as a potential recipient site for distal lower extremity VLNT.
• To evaluate the feasibility and aesthetic outcomes of VLNT in the Kager triangle.

Main Methods:

• An omentum lymph node flap was transferred to the Kager triangle in the distal lower extremity.
• Recipient vessels included the posterior tibial artery and anterior lateral malleolar artery, used in a flow-through manner.
• Direct closure of incisions was performed.

Main Results:

• The Kager triangle, containing the Kager fat pad, accommodated the lymph node flap without significant contour deformity.
• Excellent cosmetic results were achieved with direct wound closure.
• The described technique allowed for adequate compression garment fitting.

Conclusions:

• The Kager triangle is a viable and aesthetically advantageous recipient site for distal lower extremity VLNT.
• This technique addresses the challenges of flap inset in small-diameter distal limbs.
• VLNT to the Kager triangle shows promise for improving lymphedema treatment outcomes.