Investigators from Indiana University, Indianapolis, IN, and Medical College of Wisconsin, Wauwatosa, WI, conducted a retrospective study to compare long-term outcomes in children with type B ulnar polydactyly, defined as an unarticulated digit attached by a narrow neurovascular bundle or skin bridge to the ulnar aspect of the hand, treated in infancy with either ligation or formal surgical excision. Study participants were identified by review of a database of children with type B ulnar polydactyly treated during infancy at a single center between 2005 and 2014. Patients in the database were either treated with outpatient ligation, using a permanent 4-0 monofilament suture at the base of the connecting skin bridge of the extra digit, which resulted in ischemia, necrosis, and auto-amputation, or formal excision under general anesthesia. An attempt was made to contact these patients, or their parents, for a follow-up telephone survey. Survey items included overall satisfaction with treatment and satisfaction with the aesthetic appearance (both rated on a 1-10 scale with 10 representing highest satisfaction) and need for further treatment after the initial procedure. In addition, study participants completed the Patient Reported Outcomes Measurement Information System (PROMIS) Pediatric Upper Extremity survey, version 2.0, which evaluates upper extremity function. T-tests were used to compared satisfaction and PROMIS scores in children treated with either ligation or excision.
Surveys were completed on 69 of 173 eligible children (response rate 40%). The mean age at the time of treatment in these patients was 10 months, and mean age at follow-up was 11.7 ±2.6 years. There were 24 children treated with ligation and 45 who underwent surgical excision. Among those treated with ligation, 10 (42%) required future surgical excision because of a symptomatic neuroma stump or persistent polydactyly; none of the children treated with excision required revision. Overall satisfaction with treatment was significantly higher in the group of patients treated with excision than in those treated with ligation (P = 0.003). There was no significant difference between groups in satisfaction with aesthetic appearance (P = 0.07), or in PROMIS scores (P = 0.77).
The authors conclude that a substantial number of infants with type B ulnar polydactyly who are treated with ligation require future surgery, and that overall satisfaction is higher in those who undergo surgical excision as the initial treatment.
Dr Hennrikus has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
Polydactyly is one of the most common congenital hand anomalies.1 Polydactyly is classified as postaxial, preaxial, or central depending on the radioulnar location of the duplicated digits. Postaxial polydactyly, which affects the ulnar side of the hand, is most common.2 Type B ulnar polydactyly is a supernumerary, floppy digit...