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目的:探讨应用皮瓣修复小腿及足踝部瘢痕癌的适应证、皮瓣的选择及其修复效果。方法:采用回顾性队列研究方法。2008年6月—2018年12月中山大学孙逸仙纪念医院收治6例小腿及足踝部瘢痕癌患者，均为男性，年龄48～64岁，病灶面积为3 cm×2 cm～15 cm×6 cm。病灶扩大切除后缺损面积为8 cm×5 cm～22 cm×9 cm，均有肌腱或骨等组织外露。根据创面位于下肢的部位、手术体位的选择、受区吻合血管的位置、小腿是否有可利用的良好皮肤软组织等因素，选择应用游离股前外侧穿支皮瓣、背阔肌肌皮瓣或带蒂腓肠神经营养血管皮瓣进行创面修复，皮瓣面积为11 cm×8 cm～26 cm×10 cm。5例游离皮瓣或肌皮瓣供区直接缝合，1例带蒂皮瓣供区移植全厚皮片修复。观察术后移植组织瓣的血运及成活情况、皮片的存活质量、并发症情况，随访观察瘢痕癌复发及转移情况、供受区的外观及功能。结果:全部患者均顺利完成手术，移植的组织瓣全部成活且血运良好，1例供区植皮者皮片存活良好。全部患者的供区及受区创面均愈合良好，无感染、积液或裂开等表现。术后随访1～5年，均无瘢痕癌局部复发或远处转移发生；移植组织瓣质量良好，受区局部外形满意，患肢活动功能良好；供区外形良好，无功能障碍。结论:小腿及足踝部瘢痕癌切除术后有肌腱及骨等组织外露者，适用皮瓣移植修复。可根据瘢痕癌的位置、手术体位、受区吻合血管的位置、小腿是否有可利用的良好皮肤软组织等因素来选择修复的皮瓣，其中游离的股前外侧穿支皮瓣或背阔肌肌皮瓣为理想的修复选择，可获取较大的皮肤软组织，供区可直接缝合且功能不受影响。“,”Objective:To explore the indication, selection and clinical effect for application of skin flap to repair scar carcinoma in the lower leg and ankle.Methods:A retrospective cohort study was conducted. From June 2008 to December 2018, six patients with scar carcinoma in the lower leg and ankle were treated in Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University. Six cases were all male, aged 48-64 years, with the area of lesion ranging from 3 cm×2 cm to 15 cm×6 cm. After extended resection, the defect area ranged from 8 cm×5 cm to 22 cm×9 cm, with tissue of tendon, bone, etc. exposed. Free anterolateral thigh perforator flap, latissimus dorsi myocutaneous flap or pedicled sural neurovascular flap was selected to repair the wound, according to the location of the wound in the lower extremity, selection of operation position, the location of the anastomotic vessels in the recipient area, and whether there was good skin and soft tissue available in the lower leg. The size of the flap was 11 cm×8 cm-26 cm×10 cm. The donor site of free flap or myocutaneous flap was closed directly by suture in 5 cases, and the donor site of pedicled flap was repaired with full-thickness skin graft in 1 case. The blood supply and survival of skin flap, survival quality of skin graft, and complication were observed postoperatively. During the follow-up period, the recurrence and metastasis of scar carcinoma, the appearance and function of donor and recipient sites were observed.Results:All the patients completed the operation successfully, all the transplanted skin flaps survived with good blood supply, and the skin graft in one donor area survived well. The donor and recipient wounds of all the patients healed well without infection, effusion, or dehiscence, etc. All the patients were followed up from 1 to 5 years. No local recurrence or distant metastasis of scar carcinoma was found. The quality of the transplanted skin flaps were good. The shape of the recipient area was satisfactory and the function of the affected limb was good. The appearance of the donor area was good without dysfunction.Conclusions:Skin flap transplantation is suitable for the patients with tendon and bone exposure after the excision of scar carcinoma in lower leg and ankle. The skin flap can be selected according to the location of scar carcinoma, operation position, the location of anastomotic vessels in the recipient area, and whether there is good skin and soft tissue available in the lower leg. The free anterolateral thigh perforator flap or latissimus dorsi myocutaneous flap is an ideal choice for repair, which can obtain large skin and soft tissue, and the donor site can be directly sutured without affecting the function.