Local Anesthesia Alone for Postaxial Polydactyly Surgery in Infants

Comparison of Surgical Wait Times and Procedure Length in the Management of Postaxial Polydactyly Using Local or General Anesthesia

Introduction: For infants with ulnar polydactyly, surgical removal of the supernumerary digit can be performed under general or local anesthetic. This study evaluated the wait times, surgical duration, and sedation times associated with performing the procedure under local versus general anesthetic in infants with ulnar polydactyly. Methods: The databases of three surgeons at our institution were reviewed for children less than 2 years of age who underwent surgery for non-syndromic ulnar polydactyly. Data collection included patient demographics, wait times, duration of surgery and sedation and complications. Results: The study included children (n  =  55) who received treatment under local (n  =  22) or general (n  =  33) anesthesia. The wait times for the local anesthetic group were significantly shorter than the general anesthetic group (p < 0.05) for: referral to first consultation appointment; referral to surgery date, and decision date to surgery date. The duration of surgery (17.9  ±  6.9 vs 36.6  ±  20.2 min) and sedation time (26.3  ±  11.1 vs 74.8  ±  29.1 min) were significantly shorter in the local anaesthetic group (p < 0.05). There were no differences in complication rates between the groups. Conclusion: In this single-institution retrospective analysis, treatment of non-syndromic ulnar polydactyly with local anesthetic and bottle sedation was associated with shorter wait times, and duration of surgery and sedation. Level of Evidence: III, retrospective chart review and quality improvement initiative.

A Case of Postaxial Polydactyly Managed Under Local Anesthesia

Polydactyly is a common occurrence, observed as the presence of extra digit/s in the hands and feet. It can be categorized into preaxial, postaxial, and mesoaxial forms based on the location of the additional digit. In most instances only a single extra digit is present, research reports with more than one extra digit have been published. Most common management includes surgical excision under the influence of general anesthesia. An alternative approach by removing the pre-axial and post-axial supernumerary digit is carried out under local anesthesia in infants and small children, providing the additional benefit of fewer post-procedural complications. This is a case of a 5-month-old male child, with post-axial polydactyly of the left hand. He was managed by excision of the extra digit under the influence of local anesthesia. The patient recovered well and was discharged 3 days after the procedure with the advice of monthly follow-up until 3 months.

Surgical Excision of Postaxial Polydactyly Type B in the Office Setting

BACKGROUND

Simple postaxial polydactyly (type B) is a common congenital hand malformation often treated by suture or clip ligation.

METHODS

We present a case series of patients with simple postaxial polydactyly treated by surgical excision using local anesthesia in an office setting.

RESULTS

The procedure was performed on 78 digits in 48 children with a mean age of 10.2 weeks. There were no intraoperative or early postoperative complications. A follow-up by phone interview was performed at an average of 3.2 years postoperatively. All patients were reported to be pain-free and have normal function without a perceived range of motion deficits. All parents selected the highest level of satisfaction regarding cosmetic outcomes and overall experience with the procedure.

CONCLUSIONS

These results demonstrate that an office-based surgical excision is a safe, effective, and economical treatment option and has developed into our standard of care for this common condition.

Pediatric Wide-Awake Local Anesthesia No-Tourniquet Technique Hand Surgery: A Practical Approach

Pediatric wide-awake local anesthesia no-tourniquet technique (WALANT) hand surgery is feasible for the treatment of the spectrum of pediatric hand surgeries, which can include traumatic injuries and congenital hand differences. The key component for success is identifying the appropriate patient for this technique, with the typical patient frequently being >10 years of age. The discussion with the patient and adequate preparation for maximum efficiency become key for patient and surgeon comfort. Here we describe a practical approach for successfully performing this valuable technique for the pediatric population.