形成外科医に望む血行再建・軟部組織再建

Revascularization and Soft Tissue Reconstruction for Plastic Surgeons in Cases of Severe Extremity Trauma

はじめに

　重度四肢外傷は，皮膚，骨，関節，筋・腱，神経や血管など四肢の重要組織が複合的に損傷を受け，治療に難渋する重篤な外傷である 1）。このため，形成外科医が救急科や整形外科から主幹動脈の血行再建や軟部組織再建を依頼される場合も少なくない。重度四肢外傷においては，損傷血管は単純にマイクロ技術を用いて再建し，軟部組織欠損を単に皮弁や植皮でカバーすればよいわけではない。すなわち，外傷再建を腫瘍再建と同じ時間軸で考えてはならない。重度四肢外傷に特有の考え方を理解し，適切なタイミングで確かな対応をする必要がある 1）2）。

　本稿では，この重度四肢外傷に特有の血行再建と軟部組織再建における，形成外科医に必要な知識と心構えについて解説する。

　Severe extremity trauma is a serious injury that is difficult to treat because of the complex damage to the extremity, including skin, bones, joints, muscles and tendons, nerves, and blood vessels. Ischemic limbs require revascularization with full awareness of any massive hemorrhages and recirculatory disturbances. For skin and soft tissue reconstruction, it is necessary to understand the zone of injury and to plan the skin valves so that all soft tissue reconstruction can be completed within seven days.

　Before the reconstruction is requested, plastic surgeons should participate in the treatment as a team member from the patientʼs initial care to as great a degree as possible and demonstrate their knowledge and skills.