Treatment of Polydactyly in a Baby Boy
Refer the baby to a pediatric plastic surgeon for surgical removal of the extra finger, as this is the guideline-recommended specialist for hand malformations in children. 1
Specialist Referral
The American Academy of Pediatrics explicitly recommends pediatric plastic surgeons for hand trauma and malformations in children, including bone, tendon, and skin abnormalities. 1
At 1-2 years of age, this infant falls well within the age range (0-1 year for infants, 2-12 years for children) where pediatric surgical specialists are strongly preferred according to AAP guidelines. 2, 1
If a pediatric plastic surgeon is not locally available, a pediatric surgeon is an acceptable alternative, particularly since all patients 5 years or younger requiring surgical care should be managed by pediatric surgical specialists. 3
A pediatric orthopedic surgeon who manages infants with limb malformations is another appropriate option, as the AAP guidelines specify that infants with malformations of the limbs should be referred to pediatric orthopedic surgery. 2
Surgical Treatment Approach
Surgical excision is the standard treatment for polydactyly, with the specific technique depending on whether the extra digit is on the thumb side (preaxial), small finger side (postaxial), or middle of the hand (central). 4, 5
Postaxial polydactyly (affecting the small finger side) is most common and typically managed with simple excision or suture ligation of the extra digit. 4
Preaxial polydactyly (affecting the thumb side) often requires more complex reconstructive techniques to ensure a functional, stable thumb, including possible soft tissue correction or osteotomy to prevent residual deformity. 4, 5
Central polydactyly is less common and presents more challenging reconstruction. 4, 6
Timing Considerations
Timing of surgery is based on safety of anesthesia and social factors related to the child's development and interaction with peers. 7
Immediate referral is appropriate to allow the specialist to determine optimal surgical timing. 1
Critical Pitfalls to Avoid
Do not delay referral waiting for the child to grow older—early specialist evaluation allows proper surgical planning and timing. 7
Screen for associated syndromic conditions, particularly chondroectodermal dysplasia (Ellis-van Creveld syndrome) with ulnar polydactyly, as polydactyly can be associated with genetic syndromes. 7
Avoid attempting treatment by a general surgeon without pediatric training, as outcomes are significantly better when children are operated on by surgeons who preferentially treat pediatric patients. 3
If pediatric surgical expertise is not locally available, contact a pediatric surgeon at a regional pediatric surgical center to discuss whether transfer is necessary, as families should weigh the advantages of traveling to a center with appropriate expertise. 3