3. Clamp hemostat as close to the base of extra digit as

possible but without drawing up extra skin (Fig. 46.2A).

4. Tightly tie suture around digit between hemostat and

hand.

5. Keep clamp in place until digit has turned white (at

least 5 minutes).

6. Using as a cutting guide the edge of the hemostat farther from the hand, excise the digit (Fig. 46.2B).

7. Remove hemostat and observe for hemostasis, leaving

ligature in place. If there is any bleeding, reapply hemostat and ligature.

8. Cover with an adhesive bandage until residual stump

autoamputates.

Removal of Skin Tags (Fig. 46.3)

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 (6).

Chapter 46 ■ Removal of Extra Digits and Skin Tags 345

F. Complications

1. Hemorrhage

a. Failure to achieve complete hemostasis prior to

excision

b. Loosening of ligature before blood supply is

retracted

2. Infection

3. Inappropriate removal of digit or tag in presence of

related anomalies

4. Incomplete ligation leading to traumatic neuroma (1,2)

References

1. Leber GE. Surgical excision of pedunculated supernumerary digits prevents traumatic amputation neuromas. Pediatr Dermatol.

2003;20:108.

2. Mullick S, Borschel GH. A selective approach to treatment of

ulnar polydactyly: preventing painful neuroma and incomplete

excision. Pediatr Dermatol. 2010;27(1):39.

3. Horii E, Hattori T, Koh S et al. Reconstruction for Wassel type III

radial polydactyly with two digits equal in size. J Hand Surg Am.

2009;34(10):1802.

4. Gomella TL, Cunningham MD, Eyal FG, et al. Newborn physical

exam. In: Gomella TL, ed. Neonatology: Management, Procedures,

On-Call Problems, Diseases, and Drugs. 4th ed. Stanford, CT:

Appleton & Lange; 2004:35.

5. Jones KL. Preauricular tags or pits: frequent in. In: Jones KL, eds.

Smith’s Recognizable Patterns of Human Malformations. 6th ed.

Philadelphia: Elsevier Saunders; 2006;899.

6. Eley KA, Pleat JM, Wall SA. Reconstruction of a congenital nasal

deformity using skin tags as a chondrocutaneous composite graft.