Approach to type B polydactilly

[abeluchin]

It has recently been brought to my attention that the suture of the pedunculated vestigial digit in post-axial polydactilly has been associated with development of painful neuroma over time!

I have always ligated these vestigial non-bonny digits and have them follow up with their PCP.Here is some of the articles:

Pediatr Dermatol. 2010 Jan-Feb;27(1):39-42. doi: 10.1111/j.1525-1470.2009.01071.x. A selective approach to treatment of ulnar polydactyly: preventing painful neuroma and incomplete excision.

Mullick S1, Borschel GH.

Pediatr Dermatol. 2009 Jan-Feb;26(1):100-2. doi: 10.1111/j.1525-1470.2008.00835.x.

Traumatic amputation of a supernumerary digit: a 16-year-old boy's perspective of suture ligation.

Hartzell TL1, Taylor H.

Pediatr Dermatol. 2003 Mar-Apr;20(2):108-12.

Surgical excision of pedunculated supernumerary digits prevents traumatic amputation neuromas.

Leber GE1, Gosain AK.

what's your personal experience in this topic?

Thanks

[Stefan Johansson]

This is very interesting! I must admit that I was not aware of this association.

I have seen many sutures around these "extra digits", leading succesfully to necrosis. But of course, we have no long-term follow-up...

Maybe a more liberal referral to surgery in local anestesia would be a better option?