Neonatal excision of minor congenital anomalies under local anaesthetic

Stewart, Kristen; Holmes, John; Kolhe, P.S.

doi:10.1054/bjps.2001.3758

Cited by 7 publications

(5 citation statements)

References 3 publications

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“…One alternative option that might satisfy parent’s desire for the benefits of excision and timely treatment is an office-based surgical excision under local anesthetic. 16,17 However, office-based excision is often more logistically challenging as sufficient lighting, support staff, instrumentation, and patient cooperation are necessary to ensure an effective procedure. 12 The risks and benefits of minor procedures done in the office on infants, therefore, must be carefully considered.…”

Section: Discussionmentioning

confidence: 99%

Parent Perspectives for Type B Ulnar Polydactyly Management

Goebel

Loewenstein

Adkinson

2022

Hand (New York, N,Y.)

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Background: Type B ulnar polydactyly is one of the most commonly encountered congenital hand differences and can be treated with ligation or excision. The purpose of this study was to determine what factors families consider in selecting treatment for their child with type B ulnar polydactyly. Methods: We reviewed treatment outcomes and administered a survey by telephone to parents of children with type B ulnar polydactyly treated at a pediatric hospital between 2015 and 2020. We assessed satisfaction, reasons for choosing treatment, and post-management complications. Results: The families of 70 of the 156 consecutive treated patients were successfully contacted and agreed to participate (45% response rate). The mean follow-up was 27 months. Twenty-eight chose in-office suture ligation and 42 chose excision. Rapid treatment was prioritized by those who opted for in-office ligation ( P = .044). The complication rate for suture ligation was significantly higher than excision ( P < .0001), with the most common complication being a residual remnant (nubbin or neuroma stump) (64%). Respondents with residual remnant reported significantly less satisfaction with the appearance of their child’s hand ( P < .001) and with treatment outcomes ( P = .028) compared to those without residual remnants. Conclusions: Factors considered by parents in choosing type of treatment for type B ulnar polydactyly vary and may be significantly influenced by the surgeon. Although the majority of parents remain extremely satisfied with their child’s outcome regardless of management type, time to treatment plays a determinative role in parents opting for ligation rather than excision in the operating room.

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Section: Discussionmentioning

confidence: 99%

Parent Perspectives for Type B Ulnar Polydactyly Management

Goebel

Loewenstein

Adkinson

2022

Hand (New York, N,Y.)

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“…Also, the use of local anesthesia makes surgical excision a convenient and inexpensive procedure. 8,16,24,25 Our analysis revealed a paucity of rigorous and comparative studies of suture ligation and surgical excision for ulnar polydactyly. Small samples and a high risk of selection and specialty bias limit the results of any case series.…”

Section: Discussionmentioning

confidence: 99%

To Tie or Not to Tie: A Systematic Review of Postaxial Polydactyly and Outcomes of Suture Ligation Versus Surgical Excision

Chopan

Sayadi

Chim

et al. 2018

Hand (New York, N,Y.)

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Background: Ulnar polydactyly is frequently encountered in the newborn nursery and is commonly treated with bedside suture ligation. However, growing concern about the complications associated with suture ligation has led some practitioners to advocate for primary surgical excision instead. Thus, we set out to compare outcomes of suture ligation and surgical excision by systematic appraisal of the literature. Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic review was performed to identify studies published between 1950 and 2017 that described outcomes of suture ligation, surgical excision, or both. Baseline characteristics, complications, and study quality were extracted for each included article. Results: A total of 900 articles were reviewed, of which 10 studies (8 case series, 2 comparative analyses) met the inclusion criteria. There was considerable heterogeneity among the studies with respect to patient characteristics and reported outcomes. There were 2 retrospective case series of suture ligation that reported no acute complications and a variable proportion of patients with residual remnants or neuromas. Studies evaluating surgical ligation reported no acute or long-term complications, with only 1 case series reporting a small percentage of residual remnants. However, in the largest cohort analysis, the difference in complication rate was reported to be as high as 23.5% for suture ligation compared with 3% for surgical excision. Conclusions: There is a paucity of literature limiting the comparison of suture ligation and surgical excision for ulnar polydactyly. Further studies are required to determine the optimal treatment.

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“…Stewart et al described surgical excision of accessory auricles under local anaesthetic in infants under 2 weeks old. This technique has yielded good cosmetic results with high parental satisfaction, [ 6 ]. It can be performed in infants who are referred early, with the appropriate swaddling techniques, feeding, and local anaesthesia in infants up to 3 months old.…”

Section: Introductionmentioning

confidence: 99%

One-Stop Outpatient Management of Accessory Auricle in Children with Titanium Clip

Wong

Laing

Milroy

2014

Plastic Surgery International

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Introduction. Literature on ideal management of accessory auricles is limited. Traditionally, accessory auricles are managed by paediatricians with suture ligation at the base of the accessory auricle to induce ischaemic necrosis (Mehmi et al, 2007). This method can be associated with complications and poor cosmesis thus leading to the vogue of surgical excision ( Frieden et al, 1995; Sebben, 1989). We present our experience in managing these lesions in children with the application of a titanium clip in a one-stop outpatient setting. Methods. Data was collected retrospectively through review of patient records and telephone questionnaire identifying outcomes from the parents' perspective. Results. Of 42 patients, 24 (57.1%) responded. Eleven (26.2%) underwent surgical excision, 6 (14.3%) had no intervention, and 1 (2.4%) was not contactable. All parents were happy with the outcome and would recommend this management to other parents. Twenty-three (96%) had no complications apart from a tiny residual nubbin, which was considered cosmetically acceptable. One child had a residual nubbin that grew in size requiring surgical excision at later stage. Conclusion. Management of accessory auricles by the application of a titanium clip in one-stop outpatient setting is safe, simple, quick, and well tolerated with no need for admission, anaesthesia, or followup due to the low complication rate.

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Neonatal excision of minor congenital anomalies under local anaesthetic

Cited by 7 publications

References 3 publications

Parent Perspectives for Type B Ulnar Polydactyly Management

Parent Perspectives for Type B Ulnar Polydactyly Management

To Tie or Not to Tie: A Systematic Review of Postaxial Polydactyly and Outcomes of Suture Ligation Versus Surgical Excision

One-Stop Outpatient Management of Accessory Auricle in Children with Titanium Clip

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