Surgical Care
A child with distal extremity anomalies experiences emotional stress. [18] 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. [19, 20, 21, 22]
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. [23] .
When preaxial polydactyly involves the radial hand and thumb, reconstructive techniques are usually needed to ensure a functional and stable thumb. [24] Consultation with a surgeon with special expertise in hand problems is typically warranted.
A related Medscape article is Polydactyly of the Foot.
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. [22]
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Twenty-eight-day-old supernumerary digit, rudimentary nail unit cartilage (2x).
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Twenty-eight-day-old supernumerary digit, nerve bundle base (40x).
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Twenty-eight-day-old supernumerary digit, connective tissue and epidermis (40x).
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Supernumerary digit, no magnification.
