両側遊離鼡径皮弁を用いて初期治療を行った手関節以遠デグロービング損傷の2例

Degloving Hand Injury Treated with Bilateral Free Groin Flaps. Report of Two Cases

　手関節以遠のデグロービング損傷に対して，2枚の遊離鼡径皮弁の同時移植を行った2症例を報告する．症例1は46歳，男性で，プレス外傷であった．手関節以遠のデグロービングを認めたが橈尺骨動脈は温存されていた．遊離鼡径皮弁移植の後，wrap around flapと指間分離を行い，補助手として有用な手機能が得られた．症例2は38歳，男性で，ローラー外傷であった．橈尺骨動脈の断裂から手指骨壊死を生じ，骨延長による手指再建を行うも，不十分な機能獲得にとどまった．デグロービング損傷の被覆には2枚の遊離鼡径皮弁の同時移植が有用で，主軸動脈損傷の有無が予後を左右する．

　Two patients with degloving hand injury were treated with a bilateral free-groin-flap and by step-by-step reconstruction of the fingers. A degloving hand injury in a 46-year-old man avulsed the integument distal to the wrist but affected neither the radial nor ulnar artery. After a bilateral free-groin-flap transfer, his thumb was reconstructed with a wrap around flap, and his opposing fingers were reconstructed by trimming the flaps. Two years later, he returned to work with satisfactory hand function. A second degloving injury, in a 38-year-old man, also avulsed the integument but lacerated both the radial and ulnar artery. The skin was reconstructed after extensive bone resection. The thumb and one opposing finger were reconstructed by bone lengthening. Two years later, he was able to hold relatively thick objects but performed almost all activities of daily living with his uninjured hand. The bilateral free-groin-flap transfer is quite useful for covering the dorsal and volar side of the hand, including the fingers. However, the accompanying arterial damage determines the outcome of hand function in degloving injuries.