344

Nickie Niforatos

Khodayar Rais-Bahrami

Removal of Extra Digits

and Skin Tags

46

A. Indications

Removal of Nonfunctional Extra Digit

1. Prevention of accidental avulsion or torsion around

narrow base

2. Cosmetic correction at parental request

3. Consider surgical excision as an alternative to prevent

the development of amputation neuromas (1,2)

B. Contraindications

1. Concomitant illness in infant

This is an elective procedure that is painful when

the clamp is applied. To prevent accidental avulsion of

appendage if extra digit on a narrow base were to

become entangled, apply a soft dressing or adhesive

bandage until infant is stable enough for removal.

2. Bleeding diathesis

3. Additional anomalies where further surgical correction

may be necessary (3)

4. Base of extra digit >2 mm wide

5. Bone crossing the isthmus between extra digit and hand

C. Equipment

All Sterile

1. Antiseptic solution and swabs appropriate for major

procedure

2. Straight mosquito hemostat

3. Surgical silk suture, 3-0 or 4-0

4. Fine or delicate scissors

5. Adhesive bandage

6. Local anesthetic cream

D. Precautions

1. Perform procedure only on stable, healthy infant

2. Consider surgical evaluation for any questionable digit.

a. When base is >2 mm wide

b. When extra digit is on radial side of hand or is a

duplicated thumb

c. When clamping will not crush base to a thin, translucent, layer indicative of hemostasis after excision

d. When there appears to be a joint at the base

e. When bony structures are present in the digit as

confirmed by radiography (4)

3. Consider surgical evaluation for any questionable skin tag.

a. When tag may be used for ear or nasal deformity

reconstruction (5)

b. When tag is large or in critical areas

4. Apply hemostat to base of extra digit prior to placing

ligature.

a. Allows closer amputation without residual bump

b. Allows faster autoamputation or removal of most of

digit within a few hours

E. Technique

Removal of Nonfunctional Digit (Fig. 46.1)

1. Apply local anesthetic cream to appendage and base.

2. Cleanse digit and the surrounding skin with antiseptic.

Allow to dry.