Aim of the study: There is clear evidence that a painful procedure in infancy is detrimental to pain response in later life. One such painful procedure is ligating pedunculated accessory digits (PAD) with 2-0 silk ties. This ligation is often done without oral analgesics or local anesthesia after birth. Neonates invariably appear to be in pain during this procedure. An anatomical study is carried out to assess the innervation of these anomalous digits. Method: Over four years (Dec 2011- Jan 2016), 12 infants older than 6-months of age underwent excision of 14 PADs. The digits were obtained after removing them under general anesthesia. PADs were fixed in formalin, mounted in paraffin, and cut in cross-section. The sections were processed and stained by standard nerve staining techniques. Main Results: The narrowest part of the pedicle contains central blood vessels and one large, myelinated nerve bundle that distally fan out to supply the finger. PADs have similar neuroanatomy to a normal digit. Conclusion: It is recommended before excision of a PAD that local anesthesia should be injected (or applied topically) to its base. A tie can then be applied to the pedicle, and the SD excised distal to it.