高能创伤导致的下肢严重毁损伤的修复重建极为困难, 该类损伤往往伴有骨折、骨缺损、骨外露、神经血管及软组织损伤等问题。本文报告1例采用拱顶石皮瓣联合背阔肌皮瓣修复腘窝大面积软组织缺损伴神经血管外露的患者。患者因车祸致左腘窝开放性损伤, 软组织缺损面积达20 cm×40 cm, 行游离背阔肌皮瓣（10 cm×30 cm）移植覆盖腘窝部的重要神经血管等组织结构, 再用Ⅱ型拱顶石皮瓣（10 cm×20 cm）修复剩余创面。所有皮瓣均成功存活, 未出现供区并发症。术后15个月随访, 患肢外观可以接受, 膝关节未发生瘢痕挛缩。

 , Severe lower limb damage caused by high-energy trauma poses a challenge in trauma repair and reconstruction, often accompanied by issues such as fractures, bone defects, bone exposure, nerve and vascular injuries, and soft tissue damage. In this paper, one case was reported where a combination of keystone flap and latissimus dorsi flap was used to repair a large soft tissue defect in the popliteal fossa with nerve and vascular exposure. The patient sustained an open injury to the left popliteal fossa due to a car accident, with a soft tissue defect measuring 20 cm×40 cm. A free latissimus dorsi flap （10 cm×30 cm） was transplanted to cover the popliteal fossa, including important nerve and vascular structures, followed by the use of a type II keystone flap （10 cm×20 cm） to repair the remaining wound. All flaps survived successfully without any donor site complications. At a 15-month postoperative follow-up, the appearance of the affected limb was deemed acceptable, with no scar contracture at the knee joint.