Atlas of Procedures in Neonatology, 4th Edition

Miscellaneous Procedures

43

Removal of Extra Digits and Skin Tags

Leah Greenspan Hodor

Khodayar Rais Bahrami

  1. Indications

Removal of Nonfunctional Extra Digit

  1. Prevention of accidental avulsion or torsion around narrow base
  2. Cosmetic correction at parental request
  3. Prevention of traumatic amputation neuromas (1)
  4. Contraindications
  5. Presence of illness in infant
  6. Presence of bleeding diathesis

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.

  1. Presence of any other hand anomaly when further surgical correction may be necessary (2)
  2. Base of extra digit >5 to 6 mm in width
  3. Bone crossing the isthmus between extra digit and hand
  4. Equipment
  5. Iodophor antiseptic solution and swabs
  6. Straight mosquito hemostat
  7. Surgical silk suture, 3-0 or 4-0
  8. Fine or delicate scissors
  9. Adhesive bandage
  10. Precautions
  11. Perform procedure only on stable, healthy infant.
  12. Consider surgical evaluation for any questionable digit:
  13. When base is >5 to 6 mm in width
  14. When extra digit is on radial side of hand
  15. When clamping will not crush base to a thin, translucent layer indicative of hemostasis after excision
  16. When there appears to be a joint at the base
  17. When bony structures are present in the digit as confirmed by radiography (3)
  18. Apply hemostat to base of extra digit prior to placing ligature.
  19. Allows closer amputation without residual bump
  20. Allows faster autoamputation or removal of most of digit within a few hours
  21. Technique

Removal of Nonfunctional Digit (Fig. 43.1)

  1. Cleanse digit and the surrounding skin with iodophor antiseptic. Allow to dry.
  2. Clamp hemostat as close to the base of extra digit as possible but without drawing up extra skin (Fig. 43.2A).
  3. Tightly tie suture around digit between hemostat and hand.
  4. Keep clamp in place until digit turns white for at least 5 minutes.
  5. Using as a cutting guide the edge of the hemostat farther from the hand, excise the digit (Fig. 43.2B).
  6. Remove hemostat and observe for hemostasis, leaving ligature in place. If there is any bleeding, reapply hemostat and ligature.
  7. Cover with an adhesive bandage until residual stump autoamputates.

Removal of Skin Tags (Fig. 43.3)

The removal of small skin tags follows essentially the same technique as for extra digits: Clamp close to base of lesion to achieve hemostasis, and apply ligature between hemostat and normal area. If the lesions are large or in critical areas, removal is best delayed beyond the neonatal period. Consider other diagnoses associated with skin tags (4).

  1. Complications
  2. Hemorrhage
  3. Failure to achieve complete hemostasis prior to excision
  4. Loosening of ligature before blood supply is retracted
  5. Infection
  6. Inappropriate removal of digit in presence of related anomalies

P.342

 

FIG. 43.1. Nonfunctional extra digit on ulnar side of left hand.

 

FIG. 43.2. A: Place fine hemostat as close to base of extra digit as possible, and firmly secure ligature between clamp and hand. B:After finger turns white, excise digit tag outside hemostat, leaving ligature in place for autoamputation of residual stump.

 

FIG. 43.3. Skin tags of right ear and cheek. Removal of tags this large requires surgical excision rather than ligation for best result and may be associated with other malformations.

References

  1. Leber GE.Surgical excision of pedunculated supernumerary digits prevents traumatic amputation neuromas. Pediatr Dermatol.2003;20:108.
  2. Nakamura J, Kanahara K, Endo Y, et al. Effective use of portions of the supernumerary digit to correct polydactyly of the thumb.Ann Plast Surg.1985;15:7.
  3. Gomella TL, Cunnigham MD, Eyal FG, Zenk KE.Newborn physical exam. In: Neonatology: Management, Procedures, On-Call Problems, Diseases, and Drugs. 4th ed. Stanford, CT: Appleton & Lange; 1999:35.
  4. Jones KL.Perauricular tags or pits: frequent in. In: Jones KL, ed. Smith's Recognizable Patterns of Human Malformations. 6th ed. Philadelphia: Elsevier Saunders; 2006;899.