双交叉腿逆行腓肠肌皮瓣覆盖广泛的单腿软组织缺损：病例报告
Double Cross-Leg Reverse Sural Flap for Coverage of an Extensive Single-Leg Soft-Tissue Defect: A Case Report.
摘要(中文译文)
下肢远端因高能量创伤导致的大面积软组织缺损是重建外科的重大挑战，尤其当累及足跟和踝部时。逆行腓肠神经营养血管皮瓣是覆盖小腿远端和足部缺损的成熟选择；然而，其面积传统上受到限制，大面积缺损往往需要游离组织移植。我们报告一例23岁男性，因高速摩托车事故导致右足跟及踝部大面积软组织缺损，跟骨外露，合并跟骨骨折、距下关节脱位及距骨脱位。经骨折复位和多次手术清创后，仍遗留直径约18 cm的圆形缺损。由于缺乏显微外科条件，采用双侧交叉逆行腓肠筋膜皮瓣以实现充分覆盖。约14 cm的血管蒂以交叉腿方式转移，双下肢经胫骨经骨固定临时稳定三周。断蒂后，两皮瓣均显示完全血管自主性，无部分或全部坏死。供区以取自大腿后侧的刃厚皮片覆盖。随访近一年时，患者可部分行走，软组织覆盖稳定，保护性感觉保留，瘢痕成熟满意。当显微外科重建不可行时，双侧交叉逆行腓肠皮瓣可能是单侧足跟及踝部巨大缺损保肢的可行策略，拓展了逆行腓肠皮瓣在复杂创伤后损伤中的传统适应证。
Abstract
Extensive soft-tissue defects of the distal lower extremity following high-energy trauma represent a major reconstructive challenge, particularly when involving the heel and ankle. The reverse sural flap is a well-established option for distal leg and foot coverage; however, its dimensions are traditionally limited, and large defects often require free tissue transfer. We report the case of a 23-year-old male who sustained a high-speed motorcycle accident resulting in an extensive right heel and ankle soft-tissue defect with exposed calcaneus, associated with calcaneal fracture, subtalar dislocation, and talar dislocation. After fracture reduction and serial surgical debridements, a circular defect measuring approximately 18 cm in diameter persisted. Due to the absence of a microsurgical service, bilateral crossed reverse sural fasciocutaneous flaps were performed to achieve adequate coverage. Pedicles measuring approximately 14 cm were transposed in a cross-leg fashion, and both lower limbs were temporarily stabilized with transosseous tibial fixation for three weeks. Following pedicle division, both flaps demonstrated full vascular autonomy without partial or total necrosis. Donor sites were covered with split-thickness skin grafts harvested from the posterior thighs. At nearly one year of follow-up, the patient achieved partial ambulation with stable soft-tissue coverage, preserved protective sensitivity, and satisfactory scar maturation. Bilateral crossed reverse sural flaps may represent a viable limb-salvage strategy for massive unilateral heel and ankle defects when microsurgical reconstruction is not feasible, expanding the traditional indications of the reverse sural flap in complex post-traumatic injuries.
如何引用
AMA
Edgar A Flores García, Saúl Ibarra Vázquez, Jennifer Navarro Morales, Francisco J Rivera Vazquez, Abigail Diaz Alba, Gerardo A Mancillas, et al. Double Cross-Leg Reverse Sural Flap for Coverage of an Extensive Single-Leg Soft-Tissue Defect: A Case Report.. Cureus. 2026; doi:10.7759/cureus.108020.
APA
Edgar A Flores García, Saúl Ibarra Vázquez, Jennifer Navarro Morales, Francisco J Rivera Vazquez, Abigail Diaz Alba, Gerardo A Mancillas, et al (2026). Double Cross-Leg Reverse Sural Flap for Coverage of an Extensive Single-Leg Soft-Tissue Defect: A Case Report.. Cureus. https://doi.org/10.7759/cureus.108020
GB/T 7714
Edgar A Flores García, Saúl Ibarra Vázquez, Jennifer Navarro Morales, Francisco J Rivera Vazquez, Abigail Diaz Alba, Gerardo A Mancillas, et al. Double Cross-Leg Reverse Sural Flap for Coverage of an Extensive Single-Leg Soft-Tissue Defect: A Case Report.[J]. Cureus, 2026 doi:10.7759/cureus.108020.
在 PubMed增强版 阅读全文
翻译全文 · AI 文献问答 · PDF 原文下载 · 引用导出