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Revision of Neuroma after Primary Suture Ligation of Rudimentary Post Axial Polydactyly: A Case Series
Mark Tait, MD; Tyler Carllee; Kimberly McCain, RN; Theresa Wyrick, MD
Orthopedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR

Introduction: Postaxial polydactyly is a common congenital anomaly. Rudimentary forms are often treated with suture ligation. Initial treatment is often performed by Pediatricians during the perinatal period. Complications of suture ligation include painful neuroma, incomplete amputations, infection, scarring, and failure of auto-amputation. Evaluation and treatment of these complications are often referred to pediatric hand specialists. The purpose of this study was to perform a retrospective review of patients treated for neuroma formation after suture ligation of type B postaxial polydactyly.

Materials & Methods: We performed a retrospective chart review after approval from our Institutional Review Board. Patients included were referrals to a tertiary care Adult and Pediatric Hospitals for complications after string ligation. The patientís age at presentation, laterality, and gender were identified. We also recorded initial complaints at referral, pathology results and the definitive procedure performed. Definitive procedure included excision of the remaining amputation stump with excision of neuroma. Neuroma excision included dissection of supernumerary digital nerve which was then buried in subcutaneous fat. All patients were seen for postoperative evaluation.

Results: Thirteen patients (16 hands) were referred. All patients had previous string ligation. Patient ages ranged from 5 months to 36 years at presentation. All patients and families desired surgical excision. Seven specimens underwent microscopic evaluation and demonstrated traumatic neuroma while the other specimens underwent gross examination. The intraoperative examinations of all revisions were consistent with neuromas. No patients had complications related to surgical revision at postoperative visits and no recurrence of neuroma.

Conclusion: Ulnar sided polydactyly is often treated with suture ligation without complication. We have identified a case series of patients with complications related to suture ligation and the need for revision surgery. These findings would agree with other reported case series. The pathology results found in our series would also disagree with the idea that neuromas are rare in the pediatric population undergoing suture ligation. The options for initial treatment currently include observation, suture ligation, and referral to a specialist for surgical excision. Primary surgical intervention is warranted when the presence of a bony or ligamentous attachment is seen clinically or radiographically. Our case series would indicate that there are a significant number of patients that could avoid revision surgery with early referral to a specialist for early surgical excision in contrast to early suture ligation. When complications of suture ligation are found our case series would indicate that surgical revision is a successful treatment.

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