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Supernumerary Digit Treatment & Management

  • Author: Luke Lennox, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Mar 29, 2016
 

Surgical Care

A child with distal extremity anomalies experiences emotional stress.[17] By age 3 years, the child has become aware of the anomaly. By age 7 years, the child has begun to experience the close scrutiny of his peers at school. For these reasons, along with others, surgical correction should be initiated early in life.

Surgical management depends greatly on the complexity and location of the deformity. Traditionally, postaxial polydactyly was managed by pediatricians with suture ligation and only syndactyly was treated in the operating room. However, the increased risk of painful neuromas when using suture ligation has led to the use of sharp excision for postaxial polydactyly. The accessory digital nerve in postaxial polydactyly needs to be identified and transected as far proximally as is safe in order to decrease the risk of neuroma. Soft tissue then covers the end of the divided nerve. In cases of preaxial and central polydactyly, treatment is variable and the surgeon looks to find a balance between aesthetics and functionality. Waiting until age 9-12 months is advisable to decrease anesthesia risk.[18, 19, 20, 21]

Conversely, if an infant has postaxial type B polydactyly (rudimentary extra digit attached to the ulnar side by a soft tissue stalk), excision in the neonatal nursery is a safe and simple procedure with consistently positive outcomes. Excision is done with a single swipe of a scalpel after the use of topical anesthesia.[22]

A related Medscape article is Polydactyly of the Foot.

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Complications

Complications in the perioperative timeframe include those secondary to bleeding and anesthesia.

Later, decreased function due to ligamentous laxity or contracture can occur. Painful neuromas can also occur at the treatment site, especially when using suture ligation as therapy.[21]

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Contributor Information and Disclosures
Author

Luke Lennox, MD Resident Physician, Department of Medicine, University of Buffalo, State University of New York School of Medicine and Biomedical Sciences

Disclosure: Nothing to disclose.

Coauthor(s)

Thomas N Helm, MD Clinical Professor of Dermatology and Pathology, University of Buffalo, State University of New York School of Medicine and Biomedical Sciences; Director, Buffalo Medical Group Dermatopathology Laboratory

Thomas N Helm, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society of Dermatopathology

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, Sigma Xi

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Albert C Yan, MD Section Chief, Associate Professor, Department of Pediatrics, Section of Dermatology, Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine

Albert C Yan, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology, Society for Pediatric Dermatology, American Academy of Pediatrics

Disclosure: Nothing to disclose.

Carter G Abel, MD Clinical Assistant Attending, Department of Dermatology, New York Presbyterian Hospital

Carter G Abel, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery, American Society for Dermatologic Surgery, Medical Society of New Jersey

Disclosure: Nothing to disclose.

Denise M McCarthy, MD Associate Professor, Department of Radiology, Morristown Memorial Hospital

Denise M McCarthy, MD is a member of the following medical societies: American Association for Women Radiologists, American Roentgen Ray Society, Association of University Radiologists, Radiological Society of North America

Disclosure: Nothing to disclose.

References
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  9. Temtamy SA, McKusick VA. The genetics of hand malformations. Birth Defects Orig Artic Ser. 1978. 14(3):i-xviii, 1-619. [Medline].

  10. Malik S, Grzeschik KH. Synpolydactyly: clinical and molecular advances. Clin Genet. 2008 Feb. 73(2):113-20. [Medline].

  11. Tian F, Tian LJ, Zhao W, Li XC, Li B, Ji XL. Plastic repair for a case with synpolydactyly. Arch Orthop Trauma Surg. 2011 Jun. 131(6):869-73. [Medline].

  12. Castilla EE, Lugarinho R, da Graça Dutra M, Salgado LJ. Associated anomalies in individuals with polydactyly. Am J Med Genet. 1998 Dec 28. 80(5):459-65. [Medline].

  13. Jafari D, Sharifi B. A variant of mirror hand. A case report. J Bone Joint Surg Br. 2005 Jan. 87(1):108-10. [Medline].

  14. Bromley B, Shipp TD, Benacerraf B. Isolated polydactyly: prenatal diagnosis and perinatal outcome. Prenat Diagn. 2000 Nov. 20(11):905-8. [Medline].

  15. Zimmer EZ, Bronshtein M. Fetal polydactyly diagnosis during early pregnancy: clinical applications. Am J Obstet Gynecol. 2000 Sep. 183(3):755-8. [Medline].

  16. Ban M, Kitajima Y. The number and distribution of Merkel cells in rudimentary polydactyly. Dermatology. 2001. 202(1):31-4. [Medline].

  17. Eskandari MM, Oztuna V, Demirkan F. Late psychosocial effects of congenital hand anomaly. Hand Surg. 2004 Dec. 9(2):257-9. [Medline].

  18. Morley SE, Smith PJ. Polydactyly of the feet in children: suggestions for surgical management. Br J Plast Surg. 2001 Jan. 54(1):34-8. [Medline].

  19. Park GH, Jung ST, Chung JY, Park HW, Lee DH. Toe component excision in postaxial polydactyly of the foot. Foot Ankle Int. 2013 Apr. 34(4):563-7. [Medline].

  20. Dijkman R, Selles R, van Rosmalen J, Hülsemann W, Mann M, Habenicht R, et al. A clinically weighted approach to outcome assessment in radial polydactyly. J Hand Surg Eur Vol. 2015 Aug 28. [Medline].

  21. Hartzell TL, Taylor H. Traumatic amputation of a supernumerary digit: a 16-year-old boy's perspective of suture ligation. Pediatr Dermatol. 2009 Jan-Feb. 26 (1):100-2. [Medline].

  22. Katz K, Linder N. Postaxial type B polydactyly treated by excision in the neonatal nursery. J Pediatr Orthop. 2011 Jun. 31 (4):448-9. [Medline].

 
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Twenty-eight-day-old supernumerary digit, rudimentary nail unit cartilage (2x).
Twenty-eight-day-old supernumerary digit, nerve bundle base (40x).
Twenty-eight-day-old supernumerary digit, connective tissue and epidermis (40x).
Supernumerary digit, no magnification.
 
 
 
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