上腕部引き抜き切断端をfree fillet flapで被覆した1例

Avulsion Amputation of the Upper Extremity Covered with a Free Fillet Flap : Case Report

　抄録：症例は58歳，男性．2003年3月中旬，掘削機に左上肢を巻き込まれ受傷した．左上肢は上腕骨骨幹部中央レベルで完全切断され，三角筋は残存していたが，皮膚は肩関節部から剝脱していた．切断された上肢側の前腕部では橈骨，尺骨の開放性骨折と手指の不全断裂を認めた．全身合併症のため再接着術は不可能と判断し，同日切断肢を利用したfree fillet flap移植を施行した．上腕動脈とその伴走静脈を端々吻合し，断端部を皮弁で被覆した．術後10カ月の肩関節可動域は屈曲80°，外転75°である．Free fillet flapを用いることにより肩関節機能を温存でき，術後追跡期間は短期ではあるが経過良好である．外傷性の切断肢で再接着術が不可能で，緊急に創の被覆が必要な場合，free fillet flapは安全かつ有用であると考えられる．

　A 58-year-old man became entangled in an excavator and sustained an amputation of his left upper extremity at the mid-humerus level. The proximal stump was degloved up to the level of the shoulder joint. Evaluation of the amputated limb revealed a two-level injury with mid-forearm open fractures of the radius and ulna. The limb was nonreplantable because of general complications, and reconstruction was performed with an extended free forearm fillet flap from the amputated arm. The brachial artery and venae comitantes in the flap were anastomosed to the proximal brachial vessels. Four months after surgery, anterior flexion of the shoulder was 80° and abduction was 75°. Free fillet flaps have been thoroughly described as a method of tissue salvage following amputation. They allow immediate wound coverage and preservation of functional amputation-stump length without the morbidity of an additional donor site. We report a case that demonstrates the utility of this technique as reconstructive option in patients who have sustained an unreplantable upper-extremity amputation.