第Ⅱ趾partial pulp free flapで再建した小指動静脈奇形の1例

Partial Second-Toe-Pulp Free Flap for the Reconstruction of a Little Finger with an Arteriovenous Malformation

はじめに

　手指の動静脈奇形（arteriovenous malformation：以下，AVM）の手術治療において，動静脈シャントを完全に切除することが重要であることは，ほかの部位のAVMと共通である 1）。しかし一方で，手指AVMの特徴として，機能と整容性への配慮が強く求められる。したがって，病変の切除によって神経血管や腱を含む機能的構造物の広範な露出が生じる場合は，皮弁による再建が必要となる。今回われわれは，手指のAVM切除後の皮膚軟部組織欠損に対して，第Ⅱ趾partial pulp free flap（以下，PPF） 2）での再建を行い，機能と整容の両面でほぼ満足する結果を得たので報告する。

　The surgical treatment of an arteriovenous malformation (AVM) in a finger remains a challenging task because it requires a careful consideration of both function and aesthetics. We report the successful reconstruction of a finger after AVM resection with the use of a partial-pulp free flap (PPF).

　A 29-year-old male presented with a subcutaneous mass on the radial side of the proximal phalanx of his right little finger. Magnetic resonance angiography and color Doppler ultrasonography led to a diagnosis of AVM. The lesion, including the overlying skin, was completely resected. A PPF was harvested from the patientʼs second toe and transferred to cover the defect. The postoperative course was uneventful, and the flap survived completely. Four months after the surgery, excellent results were confirmed in terms of both aesthetics and function.

　Although the flap size and vessel caliber are relatively small compared to other toe flaps, a second-toe PPF is less invasive and is a useful choice for the reconstruction of a localized AVM lesion in a finger.