ECMO離脱後の左下腿コンパートメント症候群により広範な皮膚・軟部組織欠損を来たしたが集学的治療により救肢し得た1例

Extensive Soft-Tissue Loss Due to Left Lower-Leg Compartment Syndrome after ECMO, Successfully Treated with Multidisciplinary Therapy

はじめに

　コンパートメント症候群は，閉鎖した筋肉区画内での組織圧が上昇し，結果として組織虚血をきたす疾患である。また，体外式膜型人工肺（extracorporeal membrane oxygenation：以下，ECMO）は，重症呼吸不全，重症心不全患者に使用され，近年のCOVID-19感染症において社会的認知度も高まった。一方で，ECMO離脱後に下腿コンパートメント症候群が生じた報告がなされているが，多くはない 1）。われわれは，ECMO離脱後に生じた下腿コンパートメント症候群により，深後方コンパートメントを除いた広範な皮膚・軟部組織欠損を来たしたものの，集学的治療により救肢し得た1例を経験したため報告する。

　Compartment syndrome is a condition in which the tissue pressure increases in a closed muscle compartment, resulting in tissue ischemia. Extracorporeal membrane oxygenation (ECMO) is an extracorporeal membrane artificial lung that is used in patients with severe respiratory failure and severe heart failure; it has also recently gained public recognition in the context of Covid-19 infection. There have been reports of compartment syndrome after the withdrawal of ECMO. We describe the case of a 42-year-old man for whom compartment syndrome developed in his lower leg after the withdrawal of ECMO that had been administered for angina. The compartment syndrome resulted in extensive skin and soft-tissue loss except in the legʼs deep posterior compartment. The patientʼs compartment syndrome was successfully treated with multidisciplinary therapy.