To evaluate the clinical efficacy of diverse flap reconstructions for lower extremity tendon gliding wounds and analyze the treatment strategies for such defects.

From February 2021 to January 2025，20 patients with tendon gliding wounds of the lower extremity who met the inclusion criteria were admitted to the Department of Burn and Plastic Surgery，Beijing Jishuitan Hospital，Capital Medical University，including 16 males and 4 females，aged 23–68 years. The causes of injury included 12 cases of secondary wounds after lower extremity surgery，7 cases of trauma，and 1 case of infection. The wound area ranged from 2.0 cm×2.0 cm to 5.0 cm×18.0 cm. Diverse flap reconstructions were performed to repair the wounds，which included 8 cases of sural neurocutaneous vascular flaps，5 cases of free anterolateral thigh flaps，4 cases of peroneal artery perforator flaps，1 case of dorsalis pedis artery flap，1 case of lateral tarsal flap，and 1 case of local random pattern flap. The area of the flaps ranged from 3.5 cm×9.0 cm to 7.0 cm×21.0 cm. Flap viability，wound healing of donor and recipient sites，complications，flap appearance and texture，and lower limb function were assessed postoperatively and during follow-up.

All patients were followed up for 1–48 months. The flaps survived well with favorable appearance and texture. Both donor and recipient sites achieved satisfactory wound healing，and lower limb function recovered optimally.

For tendon sliding wounds of the lower extremity，the application of multiple types of flaps combined with postoperative immobilization and multi-stage rehabilitation training，could achieve satisfactory outcomes in both cosmetic reconstruction and functional recovery.