Ulnar polydactyly

What age does my baby need to be, to have surgery?

Most extra digits on the little finger side of the hand are not fully formed digits. This may have a surgical clip placed to promote the extra digit to fall off within 1-2 weeks. A small nubbin of tissue may be the only remnant in these cases that may persist as a small mark of where the digit was removed. Excision is an alternative to clip placement and can be safely performed in the newborn period with local anaesthetic while your baby feeds/is on your breast as long as the extra digit does not have any major structural features (e.g. bones or tendons). Sometimes a small stalk of skin is all that attaches the extra digit to the hand and simple excision of this and closure with a few dissolving sutures is sufficient to remove the digit and leave very little trace that the extra finger was there.

If your baby’s extra digit involves major structural features, we will need to wait until your baby is at least four months of age, and is able to tolerate a general anaesthetic. Your RPS surgeon will advise you as to whether this is necessary.

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How is this type of surgery performed in the Operating Theatre?

We prefer to wait until your baby is four months old before performing this operation under a general anaesthetic. A general anaesthetic is safer for your baby after this milestone. The advantage of this approach – as opposed to a procedure done under local anaesthetic, is that it optimises the surgical outcome given the resources available in the operating room. There are distinct advantages having a still, anaesthetised patient to operate on. It is easier to dissect out the small nerve and vessel to the finger and reshape the skin to minimise any residual skin or a residual nubbin of tissue.

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What else you should know

How will RPS manage my child's post-operative care?

RPS will give you specific advice regarding your child’s individual post-operative recovery. They will advise:

where your child will go after their surgery
what medication your child will be given or prescribed
what bandages and dressings your child will need and when they’ll be removed
when the stitches will dissolve or need to be removed
when your child can get back to normal activity and exercise
when to book follow-up care for my child

How do I care for my child at home?

After returning home from surgery, you should follow the post-operative instructions provided by the RPS team.

Remember, everyone recovers differently, but you can follow these general steps to optimise healing.

Medicine

Always speak with your RPS team to find out when you can recommence giving your child any existing medication and before starting any new medicine they have prescribed.
Always consult the RPS team before taking new medication, even if it’s over-the-counter.
Always follow the instructions provided with the medication.

Activity

When you have stitches, always check with the RPS team before your child returns to their normal activities.
After a skin graft, any exercise that stretches the skin should be avoided for at least three weeks.

Caring for your child’s wound

The wound will have a dressing covering it to help it heal and protect it from outside elements. If your child had a skin graft you may need to change the bandages. The post-operative instructions given to you will outline how to care for your child’s wound.
If your child had stitches, the RPS team will let you know when or if you have to return to have them removed. In most cases, absorbable (dissolving) sutures are used in children so they do not have to have sutures removed.
Wash the area daily with warm, soapy water and pat it dry. Ensure you don’t use any alcohol or hydrogen peroxide which can slow down the healing process.

When should I call for help?

Notify your health care team immediately if your child experiences any of the following symptoms:

nausea, vomiting or diarrhoea
fever/high temperature – 38°C or higher
your child’s stitches become loose or the wound opens
increasing pain that doesn’t improve with medication
increasing warmth, swelling or redness around incision site
pus coming from the incision site
heavy bleeding from incision site
red streaks leading to the incision site
your child can’t pass stools or gas
signs of a blood clot including pain in the calf, back of the knee, groin or thigh, redness or swelling in their leg.

If your child faints or is short of breath call 000 for emergency care.