断端形成術後に行った切断指再接着術の経験

―インフォームドコンセントの重要性について―

抄録

We describe a case of finger replantation after stump-plasty. The replantation was successfully carried out, but the case highlighted the importance of proper informed consent from the patient. The patient, a 39-year-old woman who incurred a sharp left middle finger amputation by a meat slicer, received initial treatment at a neighboring general hospital where she underwent stump-plasty. Records from this hospital revealed that treatment options were explained to the patient (replantation vs. stump-plasty) but that the patient had not opted for replantation. Nevertheless, the patient stated that as she had been in a state of distress, she had not fully understood what had been explained and had left the treatment decision to her treating physician. The same day, the patient visited our hospital with the amputated finger and requested a replantation. More than 7 hours had elapsed since the injury, but since the finger was iced and in good condition, we carried out the replantation, which required venous grafting. The postoperative course was without complications and the finger survived completely.
In the treatment of finger amputation, the gold standard is to carry out replantation, unless the patient requests otherwise. At the time of injury, patients are often in distress and lack decision-making capacity, leaving treatment decision solely to the physician. In our facility, we devote ample time to a full informed consent process, explaining treatment options, risks and benefits. This case may have been the result of an inadequate informed consent process at the first facility with the patient not fully understanding the risks and benefits; it also highlights the importance of properly conducted informed consent before surgical treatment.