第一背側中手動脈皮弁と第二背側中手動脈穿通枝皮弁によるドミノ皮弁移植で再建した母指指尖部欠損の1例

A Case of Thumb Defect Reconstruction by Domino Flap Transfer Using the First Dorsal Metacarpal Artery Flap and the Second Dorsal Metacarpal Artery Perforator Flap

はじめに

　第一背側中手動脈皮弁 1）（first dorsal metacarpal artery flap：以下，FDMA flap）は橈骨動脈より分岐するFDMAを利用した動脈皮弁であり，主として島状皮弁として母指欠損部の再建に用いられており，通常は皮弁採取部の閉鎖には植皮を要する。今回われわれは母指指尖部欠損の症例に対して，Chiらが報告したFDMA flapと背側中手動脈穿通枝皮弁 2）（dorsal metacarpal artery perforator flap：以下，DMAP flap）のドミノ移植法 3）を用いることにより皮弁採取部に植皮を要さずに再建することが可能であった。また術後も良好な結果が得られたため，文献的考察を加えて報告する。

　The first dorsal metacarpal artery (FDMA) flap is often used to reconstruct thumb defects, but it usually requires a skin graft to close the donor site. In this case, a patient with a thumb amputation was treated using a domino transfer technique that combined a dorsal metacarpal artery perforator flap with the FDMA flap, as reported by Chi. This method avoided the need for skin grafting. As a result, the patient was able to start finger movement exercises the day after surgery. This led to early discharge from the hospital and a quick return to daily activities and work. While this technique may not be suitable for all moderate thumb injuries, it offered a good alternative in this case. The choice of method considered both the patientʼs medical needs and personal circumstances. Overall, this approach was found to be effective and practical, especially when early recovery and minimal donor site damage are important.