摘要目的:探讨幼儿手部先天性并指畸形术后的瘢痕管理效果。方法:回顾性分析2018年1月至2020年1月空军军医大学第一附属医院骨科收治的手部先天性皮肤型并指畸形患儿的临床资料。全身麻醉下给予分指手术，术后采用伸直位分指包扎。切口完全愈合后，配合使用抗瘢痕药物，重建指蹼处使用自粘性软聚硅酮膜，包裹自粘弹力绷带1年，佩戴伸直位分指支具3~6个月。术后随访是否出现并发症、手指外形、外观状态。末次随访时，患儿家属对重建指蹼外形、瘢痕情况及患指屈伸活动进行满意度评价；采用美国手外科学会制定的总主动活动度(TAM)评估标准评定患指屈伸功能；采用温哥华瘢痕量表(VSS)进行术后瘢痕评分。结果:共纳入28例患儿，男12例，女16例；年龄12~34个月，平均18.3个月。左侧14例，右侧10例，双侧4例；中、环指并指16例，环、小指并指9个，示、中指并指5个，拇、示指并指2个，共32个并指。术后随访13~36个月，平均28.6个月，所有患儿术后早期无感染、血运异常等并发症，手指外形、外观状态较好。自粘性软聚硅酮膜使用过程中有2例患儿局部出现皮疹，经脱敏治疗好转后，继续正常使用。患儿家属对重建指蹼外形、瘢痕情况及患指屈伸活动均满意，满意度100%。TAM评估标准评定患指屈伸功能：优28例，优良率100%。VSS术后瘢痕评分：27例≤4分，1例5分。结论:幼儿手部先天性并指畸形术后切口愈合后，采用抗瘢痕药物，包裹自粘弹力绷带，佩戴伸直位分指支具等方法可有效防止术后瘢痕增生，更好地巩固临床治疗效果，有显著的临床应用价值。

abstractsObjective:To explore the method of scar management after the operation of congenital syndactyly.Methods:The clinical data of children with congenital cutaneous skin syndactyly of the hand admitted to the Department of Orthopedics of the First Affiliated Hospital of Air Force Medical University from January 2018 to January 2020 were retrospectively analyzed. The procedures of finger dividing were performed under general anesthesia, and the fingers were bandaged in an extended position after the operation. After the incision was healed entirely, anti-scar drugs were used in conjunction with the reconstruction of the webbed with a self-adhesive soft silicone film, wrapped with a self-adhesive elastic bandage for one year, and an extended finger brace was worn for 3 to 6 months. Postoperative complications, finger shape, and appearance were followed up. At the last follow-up, family members of the children were asked to evaluate the reconstruction effect of the webbed shape, scar condition, and flexion and extension of the affected finger.Total active movement( TAM )evaluation criteria were used to evaluate the flexion and extension function of the affected finger. The Vancouver Scar Scale (VSS) was used to evaluate the postoperative cicatrix.Results:A total of 28 children with 32 syndactyly were included, including 12 males and 16 females. The age ranged from 12 to 34 months (mean, 18.3 months). The syndactyly was unilateral in 24 patients (left in 14 and right in 10) and bilateral in 4. Among all the 32 syndactyly, there were 16 cases of the middle-ring finger, 9 cases of the ring-little finger, 5 cases of the index-middle finger, and 2 cases of the thumb-index finger. All the children were followed up for 13~36 months (mean, 28.6 months). No complications such as infection and abnormal blood supply occurred in the early postoperative period. The shape and appearance of the fingers were in good condition. While using a self-adhesive soft silicone membrane, two children developed a local rash, which was improved by desensitization treatment and continued to use usually. The family members were satisfied with the shape of the reconstructed finger web, the scar, and the flexion and extension of the affected finger. TAM evaluation criteria showed a 100% excellent flexion and extension function rate. VSS showed a 100% excellent-good rate of scar status.Conclusions:After incision healing of the reconstruction surgery for pediatric congenital syndactyly, the use of anti-scar drugs, including self-adhesive elastic bandages and split-finger braces, can effectively prevent postoperative scar hyperplasia and better consolidate the treatment effect, with distinct clinical application value.