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Office-Based "Wide-Awake" Postaxial Polydactyly Excision in Infants and Children
Trajan Alistair Cuellar, MB, BCh, MRCS(I); Christopher L. Carpenter, BSc; Michael T. Friel, MD, FAAP
University of Mississippi Medical Center, Jackson, MS

Introduction: In adult hand surgery literature, there are multiple publications highlighting the successful use of "wide-awake" hand surgery in the treatment of hand conditions. There are few instances of wide-awake hand surgery in the pediatric population present in the literature. Polydactyly of the hand is one of the most common congenital hand malformations. We present a case series of successfully performed in-office surgical excision of the Type B post-axial polydactylous digit in infants and children. The added healthcare ultilization improvements by performing this in the office, as well as lack of exposure to general anesthesia and decreased parental anxiety are reviewed.
Methods: A retrospective review of the patients treated was completed and the technique of in- office excision documented.
Results: Over a 15 month period, a total of twenty-six children were treated in the office for post- axial polydactyly. The average age of the child at the time of excision was 3.3 months old, with a median of 1.4 months with a range of 9 days to 4.2 years. There were no post-procedure complications in function or sensation.
Conclusion: We report a case series of successful surgical excision of Type B post-axial polydactyly in newborns, infants, and children in a wide-awake manner in the office setting with the use of lidocaine with epinephrine. This technique is a cost-conscious approach to the condition without the need for general anesthesia. Further, this results in decreased parental anxiety. This demonstrates excellent results with improved safety without sacrificing quality.

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