Is Epinephrine Safe for Infant Digit Excision? A Retrospective Review of 402 Polydactyly Excisions in Patients Younger than 6 Months

Plast Reconstr Surg. 2019 Jul;144(1):149-154. doi: 10.1097/PRS.0000000000005719.


Background: Conventional dogma suggests that the use of local anesthetic with epinephrine is contraindicated in the digits because of fear of ischemia and necrosis. Although several reports have refuted this notion, the precept is still propagated in many clinical forums. For many years, the authors have used lidocaine with epinephrine to perform removal of postaxial polydactyly in infants and have observed few complications and no cases of digital ischemia or necrosis. This investigation details the authors' outcomes with this anesthetic modality in neonates and supports the growing body of literature documenting the safety of using lidocaine with epinephrine in the digits.

Methods: A retrospective review of all infants younger than 6 months who underwent preaxial and postaxial polydactyly excision and removal of their sequelae of the hand or foot under local anesthesia, from 2011 to 2017, was completed. All demographic characteristics, frequency of complications, and descriptive statistics of the sample clinical group were documented.

Results: In the 215 patients who met inclusion criteria, a total of 402 procedures were performed. Mean follow-up was 19.9 months for 140 patients, or 264 procedures (65.7 percent). The total complication rate was 2.6 percent. There were two cases of minor bleeding, one wound dehiscence, and four surgical-site infections.

Conclusions: In 402 procedures of surgical excision of polydactyly in infants, there were few short-term complications, none of which were necrosis or any vascular complication related to the use of epinephrine. The authors believe that, with the use of a low-dose epinephrine injection (1:200,000), the risk for digital infarction is low in this population.

Clinical question/level of evidence: Therapeutic, IV.

MeSH terms

  • Anesthetics, Local / administration & dosage
  • Drug Therapy, Combination
  • Epinephrine / administration & dosage
  • Epinephrine / adverse effects*
  • Female
  • Fingers / abnormalities
  • Fingers / surgery
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Nerve Block / methods
  • Polydactyly / surgery*
  • Postoperative Complications / etiology
  • Retrospective Studies
  • Toes / abnormalities
  • Toes / surgery
  • Vasoconstrictor Agents / administration & dosage
  • Vasoconstrictor Agents / adverse effects*


  • Anesthetics, Local
  • Vasoconstrictor Agents
  • Epinephrine

Supplementary concepts

  • Polydactyly, Postaxial