腱付き遊離橈骨動脈浅掌枝皮弁により再建した指複合損傷の1例

Reconstruction of Complicated Index-Finger Soft Tissue Defects: Experience with the Free Superficial Palmar Branch of a Radial Artery Flap with Palmaris Longus

はじめに

　手指外傷において，皮膚欠損を伴う症例に遭遇する場面は多い。特に，関節部背側は皮下組織が薄いため皮膚欠損のみではなく，伸筋腱の欠損や関節の露出を合併しやすい 1）。腱や関節の露出を伴う皮膚欠損の場合，植皮などではなく皮弁による再建が望ましく，損傷範囲が大きい場合には遊離皮弁による再建を検討する必要がある 2）。

　今回，伸筋腱欠損を伴うPIP関節背側の皮膚軟部組織欠損に対して，橈骨動脈浅掌枝（superficial palmar branch of radial artery：以下，SPBRA）を利用した遊離皮弁に，長掌筋（palmaris longus：以下，PL）腱を付けて挙上し，伸筋腱および軟部組織を一期的に再建し，良好な経過を得た症例を経験したため報告する。

　Hand injuries involving the loss of a large amount of skin, soft tissue, and tendons are usually treated by skin coverage procedures with tendon grafts. Functional reconstruction after a severe hand injury is best achieved by obtaining primary stable soft tissue coverage and tendon repair. We treated a 48-year-old man who presented with a soft tissue defect on the dorsal aspect of the proximal interphalangeal joint (PIP) joint with extensor tendon loss. We used flaps from the free superficial palmar branch of the patientʼs radial artery (SPBRA) with the palmaris longus (PL) tendon. The flap survived completely and the wound healed satisfactorily. The donor site was closed primarily without complications or obvious scarring. The finger involved achieved a full range of motion and showed a good contour. We suggest this flap as an effective method to restore fingers with severe dorsal injuries.