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Various flaps have been used with and without skin grafts to separate digits with syndactyly. Dorsal flap techniques with and without grafts result in dorsal and thus more visible scars. Some of the recent techniques which use no grafts are only applicable for some simple syndactylies. The technique described in this paper uses a combination of techniques which have been described previously. A shaped palmar flap is used to create the web space; narrow V-flaps and full-thickness skin grafts are used to resurface the lateral defects on the fingers and reciprocal pulp flaps are used to create aesthetically pleasing nail folds. This technique allows the full thickness grafts to be hidden on the radial and ulnar sides of the fingers and palm. It increases the span of the hand in conditions where there is shortage of palmar skin. A retrospective review has been undertaken of 102 patients in whom 221 webs were reconstructed through 176 surgical procedures. There were 54 cases of simple syndactylies (53%) and the rest were complex. Complications were encountered in 11 operations (6%) and web creep was noted in 12 web spaces (5%). Re-operation for web creep has been carried out in seven web spaces (3%).

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Liver and small bowel transplant is an established treatment for infants with IFALD. Despite organ reduction techniques, mortality on the waiting list remains high due to shortage of size-matched pediatric donors. Small abdominal cavity volume due to previous intestinal resection poses a significant challenge to achieve abdominal closure post-transplant. Seven children underwent tissue expansion of abdominal skin prior to multiorgan transplant. In total, 17 tissue expanders were placed subcutaneously in seven children. All seven subjects underwent re-exploration to deal with complications: hematoma, extrusion, infection, or port related. Three expanders had to be removed. Four children went on to have successful combined liver and small bowel transplant. Two children died on the waiting list of causes not related to the expander and one child died from sepsis attributed to an infected expander. Tissue expansion can generate skin to facilitate closure of abdomen post-transplant, thus allowing infants with small abdominal volumes to be considered for transplant surgery. Tissue expansion in children with end-stage liver disease and portal hypertension is associated with a very high complication rate and needs to be closely monitored during the expansion process.

Aim:The aim of this study is to analyse the incidence of carcinoma thyroids in toxic multinodular goiters (MNG) and the pathological pattern of these cancer nodules. Methods: This is a retrospective review of 2344 patients, operated for MNG over a period of 10 years from Results: We operated on 2344 patients for MNG, out of whom 160 patients presented to us in a toxic state and the remaining 2184 in a non-toxic state. Of the patients operated for MNG 4.5% were found to have associated thyroid cancer. The incidence of thyroid cancer in toxic MNG patients was 26.25% whereas in non-toxic MNG patients it was 2.5%. All the malignant nodules detected were papillary cancers of the thyroid and relatively large nodules (range 0.6 cm-4.1 cm) were found in toxic MNG compared to non-toxic MNG. Conclusion: Patients with toxic MNG showed a very high incidence of coexisting thyroid cancer. Thyroid cancers can coexist in toxic MNG despite the suppression of thyroid stimulating hormone (TSH). The coexisting thyroid cancer size is larger in toxic MNG than euthyroid MNG. A total thyroidectomy is the treatment recommended for toxic MNG in an endemic area.

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