幼兒手部先天性并指畸形術后的瘢痕管理

張航 趙長應 鮮航 臧成五 陳永祥 叢銳

本文來源：《中華整形外科雜志》2022年08月 第38卷 第08期

DOI:10.3760/cma.j.cn114453-20211115-00441

作者單位：第一附屬醫院骨科， 西安710032

通信作者：叢銳，Email:congrui@fmmu.edu.cn

【摘要】 

目的 探討幼兒手部先天性并指畸形術后的瘢痕管理效果。

方法 回顧性分析2018年1月至2020年1月第一附屬醫院骨科收治的手部先天性皮膚型并指畸形患兒的臨床資料。全身麻醉下給予分指手術，術后采用伸直位分指包扎。切口完全愈合后，配合使用抗瘢痕藥物，重建指蹼處使用自粘性軟聚硅酮膜，包裹自粘彈力繃帶1年，佩戴伸直位分指支具3~6個月。術后隨訪是否出現并發癥、手指外形、外觀狀態。末次隨訪時，患兒家屬對重建指蹼外形、瘢痕情況及患指屈伸活動進行滿意度評價；采用美國手外科學會制定的總主動活動度（TAM）評估標準評定患指屈伸功能；采用溫哥華瘢痕量表（VSS）進行術后瘢痕評分。

結果 共納入28例患兒，男12例，女16例；年齡12~34個月，平均18.3個月。左側14例，右側10例，雙側4例；中、環指并指 16例， 環、小指并指9個，示、中指并指5個，拇、示指并指2個，共32個并指。術后隨訪13~36個月，平均28.6個月，所有患兒術后早期無感染、血運異常等并發癥，手指外形、外觀狀態較好。自粘性軟聚硅酮膜使用過程中有2例患兒局部出現皮疹，經脫敏治療好轉后，繼續正常使用。患兒家屬對重建指蹼外形、瘢痕情況及患指屈伸活動均滿意，滿意度100%。TAM評估標準評定患指屈伸功能：優 28例， 優良率100%。VSS術后瘢痕評分：27例≤4分，1例5分。

結論 幼兒手部先天性并指畸形術后切口愈合后，采用抗瘢痕藥物，包裹自粘彈力繃帶，佩戴伸直位分指支具等方法可有效防止術后瘢痕增生，更好地鞏固臨床治療效果，有顯著的臨床應用價值。

基金項目： 國家自然科學基金（82072526）

Scar management after operation of congenital syndactyly of hand in children

Zhang  Hang, Zhao  Changying, Xian  Hang, Zang  Chengwu, Chen  Yongxiang, Cong  Rui

Department of Orthopaedics, the First Affiliated Hospital of Air Force Medical University, Xi’an 710032, China

Corresponding author: Cong Rui, Email: congrui@ fmmu.edu.cn

【Abstract】

Objective 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.

Fund program: National Natural Science Foundation of China（82072526）

Disclosure of Conflicts of Interest: The authors have no financial interest to declare in relation to the content of this article.

Ethical Approval: Ethical approval was given by the Medical Ethics Committee of  the First Affiliated Hospital of Air Force Medical University（KY20223263-1）