Objective:To investigate the clinical effect of the bell-bottom flap in the treatment of multiple little toes with syndactyly deformity of the 4th and 5th toes.Methods:Forty cases (22 males and 18 females) of multiple little toes with syndactyly deformity of the 4th and 5th toes were treated in the Plastic Surgery Department of Fujian Maternal and Child Health Hospital from June 2014 to May 2020. The age of patients ranged from 6 months to 36 months, with an average of 11 months. There were 46 feet, among which 19 cases had a complete fusion, and 27 cases had an incomplete fusion. During the operation, the polydactyly was removed, the fibula-deviation deformity of little toes was corrected with the articular surface formation and joint capsule repaired. The bell-bottom flap was used to reconstruct the webbed of the toe, and the wound surface on the side was closed with three flaps made up of the residual skin soft tissue of multiple little toes. Meanwhile, the soft tissue length at the distal end of the little toe was extended, and the toenail fold and palmar flexion transverse lines were reconstructed to form a similar appearance to the normal.Results:All the flaps in all 46 feet survived with no flap necrosis, skin grafting, or infection. After 6 to 36 months of follow-up (averagely, 20 months), the width, depth, and slope of the reconstructed toe webbed were normal or close to normal, the fibula deviation of the small toe was corrected entirely, the deformity of the short toe was improved in varying degrees, no toe scar contracture, and the appearance of nail fold was consistent with that of the normal small toe.Conclusions:Bell-bottom flap is a good method to correct the deformities of small toe polysyndactyly, which can reconstruct the well-formed webbed, no skin grafting, with the shape of small toenail fold and small toe naturally, and the radians of palmar flexion line naturally.

Objective:To investigate the clinical effect of the bell-bottom flap in the treatment of multiple little toes with syndactyly deformity of the 4th and 5th toes.Methods:Forty cases (22 males and 18 females) of multiple little toes with syndactyly deformity of the 4th and 5th toes were treated in the Plastic Surgery Department of Fujian Maternal and Child Health Hospital from June 2014 to May 2020. The age of patients ranged from 6 months to 36 months, with an average of 11 months. There were 46 feet, among which 19 cases had a complete fusion, and 27 cases had an incomplete fusion. During the operation, the polydactyly was removed, the fibula-deviation deformity of little toes was corrected with the articular surface formation and joint capsule repaired. The bell-bottom flap was used to reconstruct the webbed of the toe, and the wound surface on the side was closed with three flaps made up of the residual skin soft tissue of multiple little toes. Meanwhile, the soft tissue length at the distal end of the little toe was extended, and the toenail fold and palmar flexion transverse lines were reconstructed to form a similar appearance to the normal.Results:All the flaps in all 46 feet survived with no flap necrosis, skin grafting, or infection. After 6 to 36 months of follow-up (averagely, 20 months), the width, depth, and slope of the reconstructed toe webbed were normal or close to normal, the fibula deviation of the small toe was corrected entirely, the deformity of the short toe was improved in varying degrees, no toe scar contracture, and the appearance of nail fold was consistent with that of the normal small toe.Conclusions:Bell-bottom flap is a good method to correct the deformities of small toe polysyndactyly, which can reconstruct the well-formed webbed, no skin grafting, with the shape of small toenail fold and small toe naturally, and the radians of palmar flexion line naturally.

Objective To compare the clinical features and results between transperitoneal laparoscopic radical prostatectomy and extraperitoneal laparoscopic radical prostatectomy.Methods Thirty-three prostate cancer patients treated with laparoscopic radical prostatectomy. Among them,21 cases had been done transperitoneally and 12 cases had been done extroperitoneally. The two different approaches were evaluated and compared in respects of operating time, estimated blood loss, complications during surgery, postoperative complications, intestinal function recovery time, catheterization time and length of hospital stay.Results All the surgeries had completed successfully without conversion to open surgery. For transperitoneal approach and extraperitoneal approach, the operating time was (299±46)min and (309±64)min, blood loss was (618±448)ml and (677±469)ml. There were 3 cases with severe blood loss, 2 cases with bladder injuries and 1 case with ureteral injury in transperitoneal approach group. There were 1 case with severe blood loss, 1 case with obturator never injury, 1 case with cysto-ureteral injury and 1 case with peritoneum injury in extraperitoneal approach group. For transperitoneal approach and extraperitoneal approach,the catheterization time was(14.6±3.8)d and (12.3±2.9)d, intestinal function recovery time was (2.7±0.7)d and (2.1±0.5)d, length of hospital stay was (17.0±3.6)d and (11.2±3.5)d, respectively.Conclusions Laparoscopic radical prostatectomy is feasible and safe in clinical practice. Extraperitoneal approach has better vision, less impact on abdominal organs, faster recovery and shorter hospital stay comparing to transperitoneal approach.