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Decision-making and Management of Ulnar Polydactyly of the Newborn: Outcomes and Satisfaction
Salem Samra, MD
Debra Bourne, MD
Joel Beckett, BA
Michael Matthew, MD
J. Grant Thomson, MD
University of Pittsburgh Medical Center Department of Plastic Surgery
2014-03-14
Presenter: Debra Bourne
Affidavit:
Director Name: Joseph Losee
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Hand
Background:
Polydactyly is the most common congenital hand deformity and post-axial type B ulnar polydactyly is its most common manifestation. There is currently no consensus among pediatricians or hand surgeons regarding optimal management of this condition leading to uncertainty in initial treatment decisions for infants with this type of deformity.
Methods:
Parents of newborns with type B ulnar polydactyly were enrolled in a prospective, nonrandomized trial from 2010-2012. At enrollment they were offered: 1) no treatment, 2) suture ligature, 3) immediate excision under local anesthesia, and 4) delayed excision at 4 months of age under general anesthesia. After choosing a treatment option, parents were asked to complete an initial survey on their motivation for choosing a particular option, and then additional surveys at 1 and 3 month follow-up visits regarding outcomes and satisfaction.
Results:
14 newborns were enrolled in the study. 11 patients had bilateral polydactyly for a total of 25 hands involved in the study. With statistical significance, parents chose an immediate bedside excision over all options. No surgical complications were noted and satisfaction scores were high among all groups.
Conclusions:
A majority of parents whose children are born with Type B post-axial polydactyly prefer to have the deformity addressed immediately with excision under local anesthesia at the bedside. This can be accomplished safely, with high satisfaction rates and no appreciable residual deformity. This may reduce emotional distress or embarrassment in parents who would otherwise have to deal with the deformity for at least a four-month period.
