Copyright © 2015 American Society of Plastic Surgeons. Unauthorized reproduction of this article is prohibited. www.PRSJournal.com 564 I n the adult hand surgery literature, there are multiple publications highlighting offce-based hand surgery. 1–5 There are very few instances of offce-based hand surgery in a pediatric popula- tion present in the literature. 6,7 Polydactyly of the hand is one of the most common congenital hand malformations, with multiple treatment options available for various presentations of type B post- axial polydactyly (Fig. 1) of the pediatric hand. In a recent review of the topic, Abzug and Kozin 8 present an algorithm for the management of type B polydactyly. The preference stated for initial treatment is initial suture ligation, with surgical excision reserved for the operating room when the child is aged 1 year or older. We present a case series of successfully performed in-offce surgical excision of the polydactylous digit in children as young as 2 weeks. PATIENTS AND METHODS The University of Mississippi Institutional Review Board granted approval (no. 2015-0035) for review of the charts of pediatric patients who underwent in-offce postaxial polydactyly exci- sion from November of 2013 through February of 2015. There were no patients excluded. In the offce setting, parental consent was obtained for surgical excision of the type B polydactylous digit at the time of the procedure. Surgical Technique The parents remained present in the exami- nation room for the entire procedure. The ulnar aspect of the polydactylous hand was prepared with an alcohol swab and the base of the poly- dactylous digit was injected with 0.2 ml of 0.5% lidocaine with 1:200,000 epinephrine. The surgi- cal team would leave the examination room for a Disclosure: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this article. Copyright © 2016 by the American Society of Plastic Surgeons DOI: 10.1097/01.prs.0000475787.67693.e7 Christopher L. Carpenter, B.A. Trajan A. Cuellar, M.B., B.Ch. Michael T. Friel, M.D. Jackson, Miss. Background: In adult hand surgery literature, there are multiple publications highlighting the successful use of offce-based hand surgery in the treatment of hand conditions. There are few instances of offce-based hand surgery in the pediatric population present in the literature. Polydactyly of the hand is one of the most common congenital hand malformations. The authors present a case series of successfully performed in-offce surgical excision of the type B postaxial polydactylous digit in infants and children. The added health care utilization improvements by performing this in the offce, as well as lack of exposure to general anesthesia are reviewed. Methods: A retrospective review of the patients treated was completed and the technique of in-offce excision documented. Results: Over a 15 month period, a total of twenty-six children were treated in the offce for postaxial 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–4.2 years. There were no postprocedure complications in function or sensation. Conclusions: The authors report a case series of successful surgical excision of type B postaxial polydactyly in newborns, infants, and children in an offce setting with the use of lidocaine with epinephrine. This technique is a cost- conscious approach to the condition without the need for general anesthesia. This demonstrates excellent results with improved safety without sacrifcing quality. (Plast. Reconstr. Surg. 137: 564, 2016.) CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV. From the University of Mississippi Medical Center. Received for publication May 6, 2015; accepted September 21, 2015. Offce-Based Post–Axial Polydactyly Excision in Neonates, Infants, and Children cpt IDEAS AND INNOVATIONS