According to the degree of scar contracture of the back of hand, it can be divided into mild, moderate and severe. Most mild and moderate claw-like hand deformities can be completed by one operation. Scar excision was performed in 33 hands, and contracture was completely relieved. Full-thickness autologous skin transplantation was used to correct the deformity of metacarpophalangeal joint dorsiflexion and interphalangeal flexion, and Z-shaped or five-flap method was used to open the mouth. For severe clawed hands, abdominal pedicled subdermal vascular network flap is feasible because of tendon exposure. Pedicel breaks in 3 weeks. In order to restore the function to the greatest extent after severe claw surgery, if it is expected that one operation is difficult to achieve satisfactory results, it can be repaired in two stages. The purpose of the first stage operation is to restore the metacarpophalangeal joint and set up a stall outside the thumb, which can restore the function of pinching the hand and achieve the function of aligning the palm with the line. In the second stage, the flexion deformity of interphalangeal joint was corrected, so that the interphalangeal joint was in a straight position, the function of hand clenched fist was restored, and the wound flap was repaired. For epidermal necrosis or small area skin necrosis, change the dressing every 2-3 days until the wound heals.

Suggestion:

repair

(1) massage

Massage, such as kneading, pinching, playing, pulling, etc. You should give it to your child every day, from light to heavy, slowly. In the process of massage, drugs for softening scars should be applied locally to increase local lubrication, and drugs should be immersed in subcutaneous tissue and joint space to promote scar softening and facilitate finger function exercise.

(2) Warm hand bath

Immerse in warm water at 39℃ ~ 40℃ and move passively. With the help of the buoyancy of water, the hand movements can be lighter, the pain can be relieved, and the joint range of motion can be increased. After soaking, you can apply anti-scar cream and film to prevent scar hyperplasia and relieve itching.

(3) Active and passive activities

According to the child's age, deformity and the effect of postoperative recovery, make a functional exercise plan with family members to inform parents of the importance of functional exercise and the consequences of not exercising. Surgery only provides conditions for functional rehabilitation, and functional exercise is the key to restore hand function. It is mainly the passive movement of finger joint extension, metacarpophalangeal joint flexion, thumb abduction and palm and fist training, and the auxiliary effect of elastic support is better. You can also play with games or toys. Encourage children to do what they can to achieve normal functional position as much as possible, but it is appropriate for children to bear pain, and gradually increase the intensity and range of joint activities to prevent scar hyperplasia caused by secondary trauma and excessive activity of hands. Anti-contracture functional exercise should last for more than half a year to ensure the good functional state of each joint.

(4) Elastic traction

It is an effective way to exercise the functions of finger flexion and extension, fist clenching and thumb adduction and abduction by using various splints and elastic braces, combined with the continuous and slight traction elasticity of rubber bands, and do 10 ~ 20 times for each movement. Adjust the size and shape of the brace in time according to the recovery of joint function.