To investigate the repair timing and operation method for palmar scar of finger in children under 3 years of age.

From March 2012 to December 2024， 52 pediatric patients under 3 years of age with isolated palmar finger scar hyperplasia with or without contracture deformity were admitted to the Department of Burns and Cutaneous Surgery of the First Affiliated Hospital of Air Force Medical University， and the Department of Burns， Plastic Surgery and Wound Repair of Ankang Central Hospital， including 28 males and 24 females， aged （1.6±0.7） years with a total of 151 fingers affected. Based on the extent of scarring and finger function， the fingers were classified into typeⅠ， type Ⅱ， and type Ⅲ. Type Ⅰ fingers were managed conservatively with regular follow-up， and surgical intervention was considered after scar softening depending on the degree of impact on finger function. Type Ⅱ fingers were primarily managed conservatively， with Z-plasty flap repair performed after scar softening and web-like scar formation， thereby avoiding skin grafting. Type Ⅲ fingers underwent surgical treatment， including resection of hypertrophic scars and thorough release of contractures. Local flaps from the lateral fingers were used to repair the finger web and the first transverse crease， while secondary wounds were covered with full-thickness autologous skin grafts. During the operation， Kirschner wires were used to immobilize the fingers in an extended position within the soft tissue without penetrating the phalanges. Observed the improvement of finger appearance and function during follow-up.

All 45 type Ⅰ fingers were managed non-operatively and followed up for 1–5 years with normal finger function. Among the 36 type Ⅱ fingers， 8 fingers received local flap transfer repair during the scar proliferation stage， and 28 fingers underwent local flap transfer repair after web-like scar formation， with a follow-up of 1–6 years. None required autologous skin grafting. All 70 type Ⅲfingers underwent surgical treatment according to the planned protocol. Postoperatively， both flaps and skin grafts survived completely， with satisfactory restoration of finger function， no secondary surgical intervention was required during a follow-up of 1–7 years.

Clinical classification of simple palmar finger scars in children， along with appropriate selection of therapeutic timing and surgical methods， can protect finger function and growth， reduce the number of operations， and achieve better therapeutic outcomes.