小指デュピュイトラン拘縮の再発に対し，広範囲皮膚腱膜切除，全層植皮を行った1例

Dermofasciectomy with Full Thickness Skin Graft for Recurrent Dupuytren Contracture in the Little Finger : Case Report

　抄録：小指Dupuytren拘縮の再発例に対し，広範囲皮膚腱膜切除，全層植皮を行った1例を報告する．症例は67歳，男性，1999年5月，右小指Dupuytren拘縮により腱膜切除を受けたが，翌年9月頃より再発を認めていた．手術創には，ケロイドや，近位指皮線を交差する線状瘢痕がありPIP関節は25°の屈曲変形を認めた．触診では皮下に手掌尺側から小指固有指部尺側へ走行する索状硬結を認めた．小指固有指部の皮膚をケロイド，線状瘢痕，索状硬結を含めて広範切除し，鼡径部から全層植皮を行いtie overで固定した．術後2週でtie overを除去後，可動域訓練を行った．術後1年7カ月で病巣の再発はなく，指関節の総伸展不足角度は5°，総屈曲角度は230°であった．広範囲皮膚腱膜切除，全層植皮は再発例の多い欧米で積極的に行われているが，本邦での報告はほとんどない．再発例で皮膚状態が悪く，病巣の皮膚浸潤が想定される例に対し，本法は有用な治療であった。

　We report a case of radical dermofasciectomy with full-thickness skin graft due to recurrent Dupuytren contracture in the little finger. A 67-year-old male patient had a history of limited fasciectomy in his left little finger. But 16 months postoperatively, he noticed a recurrence in the affected finger. On examination his left little finger showed 25°extension loss of PIP joint associated with palpable cord, keloid, and longitudinal linear scar. At surgery the cord arose at the abductor digiti minimi muscle, and attached firmly to the overlying skin. The neurovascular bundle was enclosed in the cord at the level of proximal finger crease. The palmar skin of the little finger was widely excised including the pathological cord, keloid, and longitudinal linear scar in order not to damage the neurovascular bundle. The defect was resurfaced with a full-thickness graft from the groin, and the graft was fixed with a tie-over dressing. The dressing was removed 2 weeks postoperatively, and ROM exercise was instituted. Nineteen months postoperatively, graft showed good durability, sensation, and texture match, and there was no evidence of recurrence. The total active range of motion has been restored to 225°. Because we could not rule out the possibility of extensive invasion of the overlying skin, we selected this operation and achieved excellent results.