Polydactyly removal

What is polydactyly (accessory digits)

Polydactyly is a birth anomaly where the person has extra fingers or toes (digits). The extra digits most commonly occur on the little finger side of the hand but they can also be located on the thumb side, with two thumbs, or more rarely in the centre of the hand. The digit can be attached by skin and soft tissue only or there may be bone and/or a joint involvement. This leaflet will provide you and your family with some information to help you understand the condition and proposed treatment.

Why remove an extra digit?

The extra digit is attached to the hand or foot by a narrow piece of skin. This digit is not needed. It can become twisted blocking the blood supply, causing a risk of the infection.

Before the operation

You and your child will be seen in clinic by a consultant plastic surgeon and your child will be added to a waiting list at this visit. Photographs are normally taken during this appointment. If the surgeon believes that the extra digit has bone growth in your child may be sent for an X-ray. You can ask any questions that you may have.

In due course, you will receive a telephone call or a letter to offer you a date and time to come in for your child’s surgery. You will also be given an appointment with the children’s pre-operative assessment. The purpose of this is to check that your child is well enough for the procedure. The clinician may also order further tests such as blood tests or further scans or refer to an anaesthetist.

Please make sure that you have a supply of paracetamol and ibuprofen, if your child can take these, at home to give to them after the operation.

If your child becomes unwell after they have been listed for surgery, please let the admissions team know. This is very important as the surgery may need to be postponed due to the increased risk of side effects of giving anaesthetic to your child, depending on what illness they have.

On the day of surgery

When your child arrives on the ward

Please arrive on the ward on the correct date and time of admission for your child’s planned surgery. Please make sure that fasting instructions (when your child is not allowed to eat or drink) have been followed precisely. If these have not been followed, the procedure may not go ahead.

Please be aware that the time of admission is not the time that your child will go down to theatre for their surgery. The order of the operating list is organised by the age and clinical need of all the children on the list, so please be prepared to wait.

A nurse will admit your child to the ward. This includes checking your child’s details, if they have any allergies and checking your child’s temperature, pulse and blood pressure. Numbing cream may be applied to your child’s hands depending on their age, if they are going to sleep during the operation.

You will see the surgical team who will ask you to give written permission (consent) confirming that you agree the procedure can go ahead. Before signing the consent form the surgical team will discuss with you what the procedure includes and the risk and benefits of carrying out the surgery. You can ask any questions that you may have about the procedure. They will also mark the area to be operated on with a surgical marker pen, this is done with the parents present.

The anaesthetist will also see your child before they go to the theatre. They will check your child is medically fit for the procedure and to have a general anaesthetic, if your child is having this. They will also discuss the different ways that anaesthetic can be given, and which method would be best for your child.

Your child will change into a gown to go to theatre.

You can be with your child going to the anaesthetic room and stay while your child goes to sleep. You will not be able to accompany your child into the operating theatre. A member of staff will take you through to recovery, where recovery staff will take a contact number to call you on to inform you that your child has had the procedure and is in recovery.

In theatre

If your child did not have a cannula inserted in their hand in the anaesthetic room, they will have one inserted once they are asleep. They will have the cannula so that medications can be given during the operation and after surgery if required.

Once your child is asleep, local anaesthetic is injected into the area to be operated on. This will ensure that your child is comfortable after the operation.

The extra digit is then removed, and stitches (sutures) are used to close the skin. Steristrips (paper sticky strips) and a bandage are normally applied.

After the operation

You will be contacted by the recovery team when your child is starting to wake up.

After surgery your child may feel drowsy or sleepy. They may also be restless and upset after waking from surgery - this normally settles on its own.

Your child can eat and drink once they feel able to after the procedure.

There may be swelling and bruising to the surgery area. This will go down naturally helped by raising the limb and should settle on it’s own over the following days/weeks.

You may go home once your child has eaten, drank and passed urine. We will also make sure that your child is comfortable after the procedure, before they go home.

After you go home

Paracetamol and ibuprofen should be given regularly for the first couple of days.

The dressing will need to be kept dry.

Keep the limb raised as much as possible, to reduce swelling to the limb and reduce pain.

It is normal for there to be some ooze from the wound after surgery. Once you are at home, if there is any fresh blood visible around the wound, please contact the children’s plastic surgery CNS (Clinical Nurse Specialist) or attend A&E.

You may have a follow-up appointment in the children’s dressings clinic at the hospital or with the nurse at your GP surgery for a dressing change.

Your child will have a follow-up appointment with a plastic surgery consultant.

Signs of infection

• Redness around the wound or spreading away from the wound.
• Increased pain to the wound that is much greater than you would expect given the surgery carried out.
• The wound is hot to touch, when compared with the temperature of the surrounding skin.
• There is a foul smell coming from the wound.
• There is pus or excessive ooze from the wound.
• Your child has a temperature and feels unwell

If any of these signs appear please contact your GP, however if your child is very ill take them straight to A&E immediately.

Medication

If your child has any prescribed medication , bring all of their medicines (including inhalers, injections, creams, eye drops or patches) and a current repeat prescription from your GP to the hospital.

Please tell the ward staff about all of the medicines your child uses, including non-prescribed medicines. During your child's stay if you wish to give your child their medication yourself please speak with your nurse before doing this. Pharmacists visit the wards regularly and can help with any medicine queries.

MyChart

We would encourage you to sign up for MyChart on behalf of your child. This is the electronic patient portal at Cambridge University Hospitals that enables patients to securely access parts of their health record held within the hospital’s electronic patient record system (Epic). It is available via your home computer or mobile device

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If you are interested in this please let us know and we can provide information, or look on our website: MyChart

Contacts/further information

Paediatric plastic surgery CNS: 07729107964

Email paediatric plastic surgery