Hi there,

My neonatology attending asked me to ligate a baby's preauricular skin tag. She acts like it's no big deal. I don't feel comfortable with doing this non-urgent procedure that could easily be taken care of as an outpatient with a plastic surgeon. It's on the baby's face and minimal scarring would be ideal.

My question is: how do other units manage the cosmetic aspect of a baby with a preauricular skin tag? Do you take care of it while the baby is in the unit or discharge the baby to have them follow up somewhere as an outpatient?

Do you ligate extra digets?

This is an interesting question.

Our strategy is to ligate a preaurical skin tag if it is are thin-based. Multiple tags and broad-based are referred to the ENT surgeon for excision.

The ligation is done after admin of 30% sucrose.

I have only seen a few infants "post-ligation" and the cosmetic result has been excellent. My main concern lately has rather been whether one gets good enough pain relief with sucrose. Some infants reacts with more pain than they deserve for this procedure, that's my opinion.

Extra digits - same strategy. Very thin-based are ligated whereas broad-based are referred.

We do not ligate Preauricular tags and leave it to the Plastic surgeon for later removal. Extradigits on the Ulnar side without a bony connection and the base is <5-6 mm in width is removed under local Lidocaine and oral sucrose as per Atlas of Procedures in Neonatology, 4th edition, MacDonald and Ramasethu, 2007 Lippincott Williams & Wilkins. After antiseptic precautions, a hemostat is placed as close to the base of the extradigit without drawing up extraskin. A suture 3 O silk is tied tightly between the hemostat and the hand. hemostat is kept in place for at least 5 minutes till the digit turns white. the digit is excised over the hemostat with a #15 blade. (# 10 or #11 is OK ), hemostat is removed and the ligature left in place. this is covered by an adhesive bandage. the residual stump falls off after a few days. With this procedure, the results are excellent and one can hardly see the stump after a few weeks.

Shantha Karanth, MD, Prince William Hospital, Manasssas, VA, USA

I browsed J of Pediatrics today and found this case report:

http://www.jpeds.com/article/S0022-3476%2809%2900839-7/fulltext

The authors write that this complication is not previously reported, but I have seen one in my unpublished policlinic once