Background.To carry out high-quality breeding work in the cattle populations, it is necessary to use next generation sequencing (NGS) methods, which allow large samples of the animals to be assessed for a significant number of the single nucleotide substitutions (SNPs) in a short period of time. Materials and methods.Genotyping of the Holstein black-and-white cattle bred in the Central Black Earth region of Russia (Belgorod region) was carried out using NGS sequencing (multilocus panel TruSeq® Bovine Parentage Kit, Illumina USA). Results.It was found that most of the animals studied are the inter-line hybrids.Correlation analysis of the "Reflection Sovereign", "Montvik Chieftain" and "Vis Back Ideal" lines showed no correlation dependency (r=0,165, p=0,106). Additionally, 10,4% of the cattle were carriers of the gene related to the Holstein red-and-white coat color. Furthermore, 61,5% of the cattle were carriers of the mutant allele G (_SNPchr8_108833985), which lowers immunity and contributes to the development of moraxellosis. Carriers of several unfavorable mutations were identified, such as Syndactyly (SY) – 8,3%, mutations leading to leukism (MITF gene) – 12,3%, and mutations in the melanocortin receptor gene (MC1R) – 10,4%. Carriers of the semi-lethal mutation (allele T) in the APAF1gene accounted for 3,0% of the cattle, carriers of the lethal mutation (allele C) in the HH3gene – 14,6%, carriers of the lethal mutation (allele C) in the HHB(BLAD) gene – 1,0%, carriers of the semi-lethal mutation (allele A) in the SLC35A3 gene – 2,0%. All this indicates errors in the breeding work. Against the backdrop of these unfavorable genetic factors, carriers of mutations with a positive effect on meat and milk productivity were observed, namely carriers of the MSTNgene mutation (allele T) – 50%, carriers of the ABCG2gene mutation (allele C) – 4.2%, carriers of the DGAT1gene mutation (allele A) – 28,1%, carrier of the CSN1S1gene mutation (allele A) – 1,0%. Conclusion.We believe that adjusting the breeding work regarding these mutations, both with negative and positive effects, will allow farms to create core herds of high-productivity animals, which will contribute to increasing the quantity and quality of dairy products.

BackgroundLittle is known about the epidemiologic features of syndactyly (SD) in Chinese newborns.MethodsUsing 2007–2019 data from the Chinese Birth Defects Monitoring Network, we conducted a prevalence analysis on overall, isolated and associated syndactyly according to birth year, maternal age, maternal residence, geographic region and infant sex, with special interests in time trends, perinatal outcomes and clinical phenotypes.ResultsA total of 13,611 SD cases were identified among 24,157,719 births in the study period, yielding the prevalence of 5.63, 4.66 and 0.97 per 10,000 for overall, isolated, and associated SD, respectively. The prevalence of each type of SD exhibited an upward trend over the period. The prevalence of overall SD varied significantly by maternal residence (urban vs. rural, 6.69/10,000 vs. 4.35/10,000), maternal age (< 20 years, 5.43/10,000; 20–24 years, 5.03/10,000; 25–29 year, 5.65/10,000; 30–34 years, 6.07/10,000; ≥ 35 years, 5.76/10,000), geographic region (central, 5.07/10,000; east, 6.75/10,000; west, 5.12/10,000), and infant sex (male vs. female, 6.28/10,000 vs. 4.86/10,000). Newborns with associated SD were more likely to be born prematurely (29.2% vs. 10.6%) or with low birthweight (30.5% vs.9.8%) than those with isolated SD. The bilaterally, and unilaterally affected cases accounted for 18.4% and 76.7%, respectively. The feet were more frequently involved (64.3%) in those bilaterally affected cases, while right side preference (right vs left: 53.8% vs 46.2%) and upper limbs preference (hand vs foot: 50.8% vs 48.0%) were found in unilateral cases.ConclusionsThe prevalence of syndactyly in China is on the rise and notably higher than that in other Asian and European countries, highlighting the importance of investigating the etiology, epidemiology, and clinical implications of this condition in the Chinese population.

A comprehensive summary of recent knowledge in syndactyly (SD) is important for understanding the genetic etiology of SD and disease management. Thus, this review article provides background information on SD, as well as insights into phenotypic and genetic heterogeneity, newly identified gene mutations in various SD types, the role of HOXD13 in limb deformities, and recently introduced modern surgical techniques for SD. This article also proposes a procedure for genetic analysis to obtain a clearer genotype–phenotype correlation for SD in the future. We briefly describe the classification of non-syndromic SD based on variable phenotypes to explain different phenotypic features and mutations in the various genes responsible for the pathogenesis of different types of SD. We describe how different types of mutation in HOXD13 cause various types of SD, and how a mutation in HOXD13 could affect its interaction with other genes, which may be one of the reasons behind the differential phenotypes and incomplete penetrance. Furthermore, we also discuss some recently introduced modern surgical techniques, such as free skin grafting, improved flap techniques, and dermal fat grafting in combination with the Z-method incision, which have been successfully practiced clinically with no post-operative complications.

The previously reported LRP4 c.4940C>T variant is not associated with syndactyly in cattle.

Objective To evaluate the surgical technique and clinical effect of free KISS anterolateral thigh flap in repairing soft tissue defect of dorsal side of fingers. Methods From January, 2014 to June, 2019, 7 patients with soft tissue defects in dorsal side of multiple fingers were treated. Step one, a KISS anterolateral thigh flap was used and a temporary syndactyly between adjacent affected fingers was created by suture of the digital palmar skin. The donor sites were sutured directly. Step two, a procedure of partial de-bulking and division of syndactyly was followed-up 1-3 months later. All cases were followed-up in observations of appearance, texture, functions and donor site of flaps. Results All flaps survived, and all went through disorders of no blood circulation. The followed-up time were 3 to 24 (average 12.5) months. The flaps had fine appearance, texture and colour. The dorsal aspects of reconstructed fingers demonstrated an aesthetically pleasing effect after the flap de-bulking and division of syndactyly. The donor site only left a linear scar, and the thigh had no functional deficit. Conclusion Free KISS anterolateral thigh flap in repairing defects of dorsal skin in multiple fingers could simplify the operation, shorten operative time and reduce surgical trauma. Key words: Anterolateral thigh flap; Finger; KISS flap; Repair; Microsurgical operation

Objective To discuss the application of plane-shaped flaps for reconstruction of the web space in polysyndactyly of the fifth toe fused with the fourth toe. Methods A total of 62 cases (81 feet) with polysyndactyly of the fifth toe fused with the fourth toe were involved in the study, 53 of which were incomplete and 9 were complete fusion of the fourth and fifth toe. The fifth toe showed various degrees of fibular clinodactyly and minor deformities. Excision of polydactyly and then using arthroplasty or osteotomy correction deviation was for fibular clinodactyly. All plane-shaped flaps were used for reconstruction of the web space deeply, and the lateral sides of toes were closed with flaps and the distal soft tissues of polydactyly were used lengthening the reconstructed fifth toe. Brachydactylias were improved, and nail folds were reconstructed. Thus, the appearances reached the normal level. Results All the webs were reconstructed primarily without skingraft. After 12 months of follow-up, these reconstructed web space were satisfied with good appearances of width, depth and gradient. The fibular clinodactyly was completely corrected, and brachydactylias were corrected in various degrees. Nail folds reached the normal ones. Conclusions Plane-shaped flap in polysyndactyly of the fifth toe fused with the fourth toe for reconstruction of the web space is satisfactory. The reconstructed webs not only achieves good appearance, but also avoids skin grafts. It is one of the best choices of the polysyndactyly treatment. Key words: Reconstructive surgical procedures; Child; Polysyndactyly of the toes; Syndactyly; Web space reconstruction; Plane-shaped flap

To explore the genetic basis for a child with developmental delay and congenital syndactyly. G-banding chromosomal karyotyping and chromosomal microarray analysis (CMA) were performed on peripheral blood sample from the child. The child was ascertained as 46, XY, r(18)[52]/45,XY,?18[3]. A 18q21.32-q23 deletion was identified by CMA with a size of 19.85 Mb, which has encompassed 99 genes including CTDP1, TXNL4A, TSHZ1, PIGN, RTTN, TNFRSF11A, KDSR and CYB5A. Clinical phenotype of the patient with ring chromosome 18 is associated with the size of the euchromatin loss and involved genes. As a useful complement to conventional karyotyping, CMA has provided an powerful tool for delineating complex chromosomal aberrations.

Objective To investigate the surgical treatment of the congenital distal syndactyly in constriction band syndrome during neonatal period. Methods From January 2014 to April 2018, 6 cases of congential constriction band syndrome with distal syndactyly in neonatal period were treated by early finger segment division under local anesthesia. The full-thickness suture of incision or direct application of sterile dressing was performed. Results All the patients were follow-up for 6 to 13 months with an average of 8.6 months. All the incisions achieved healing within 2 weeks after operation, and there were no complications such as infection and necrosis of the distal finger skin. The appearance and grip function of the affected fingers were significantly improved compared with those before operation. Moses evaluation criteria were used to evaluate 6 cases with excellent results. Conclusion The children with congenital distal syndactyly in constriction band syndrome can be operated on as early as possible in neonatal period, and satisfactory results can be obtained. Key words: Hand deformities,congenital; Surgical procedures,operative; Neonatal period; Distal syndactyly in constriction band syndrome; Local anesthesia

Objective To explore the clinical efficacy of modified pentagonal dorsal finger flap in the congenital syndactyly release. Methods From January 2010 to January 2014, 20 cases of simple cutaneous syndactyly were treated by modified pentagonal dorsal finger flap combined with finger Zigzag flap. The flap coverage scope, the occurrence of infection and necrosis of the skin flap and other early complications were recorded. The web depth and finger extension angle were measured and compared with the healthy side. Finger web creep and finger web scar were scored, and whether reoperation was performed due to the above complications was recorded. Questionnaire was used to evaluate parents' satisfaction. Results Twenty patients were follow-up for 30 to 75 months, with an average of 38 months. No complications such as infection and necrosis of skin flaps occurred after operation. The shape of the web was wide. The web depth of the affected side was (2.37±0.56) cm, and the finger extension angle was (24.50±4.74)°. There was no significant difference between the affected and healthy side. The reoperation rate due to web creep, web contracture and scar flexion contracture was 0. Family members were satisfied with the treatment outcome. Conclusion The modified pentagonal dorsal finger flap combined with finger Zigzag flap can reconstruct web space to the level of proximal interphalangeal joint, reduce the complications such as web creep and scar contracture after operation. Wide web is good for fingers to grasp large objects with high operative safety. Key words: Hand deformities,congenital; Syndactyly; Modified pentagonal dorsal finger flap; Web reconstruction; Web contracture

Objective To study the surgical techniques and the clinical curative effect of the reconstruction of adjacent large finger pulps with the modified sensate free proximal ulnar artery perforator flap. Methods From February, 2013 to May, 2016, 20 fingers in 10 patients with adjacent large finger pulp defects crossing the DIP joint were reconstructed by the modified senate free proximal ulnar artery perforator flap. All the pulps of every patient were recovered by 1 flap in the first stage and the artificial syndactyly of two digits was divided in 7 weeks after the flap transfer in the second stage. In order to reconstruct the sensation of two pulps in each patient, firstly both of the proximal and distal ends of the cutaneous nerve in flaps were dissected and anastomosed with the most lateral and medial palmar digital nerves of two adjacent fingers respectively, which were divided into 2 groups. Secondly the cutaneous nerve in the middle part of flap was cut and the two ends were anastomosed with the other two palmar digital nerves in the second surgery. There were 8 fingers in 4 patients with the index and middle finger pulp defects, 12 fingers in 6 patients with the middle and ring finger defects. The flap size was from 5.0 cm×3.5 cm to 5.5 cm×4.0 cm, and the perforator artery was anastomosed with the palmar digital artery in 6 cases and with the joint branch of digital artery in 4 cases. Results Nine flaps survived uneventfully except the venous congestion was found in 1 flap which was salvaged successfully by acupuncture bleeding. Also, no congestion or ischemia of all the 20 pulp flaps occurred right after releasing the artificial syndactyly. The time of followed-up was from 11 months to 32 months with the average of 17 months after the second surgery. The static two point discrimination of the 2 groups of the sensate pulp flap was (7.3±1.2) mm and (8.6±2.4) mm respectively. There was no significant difference between groups (P > 0.05). These 20 pulp flaps were also assessed by the Semmes - Weinstein monofilament test with the result of diminished light touch in 14 pulps and diminished protective touch in 6 pulps. The total active motion in all 20 fingers was (248.0±4.5) °. No patients suffered cold intolerance and local pain but 1 had hypersensitiveness in the pulp flap. Conclusion The modified sensate free proximal ulnar artery perforator flap is a practical alternative for the reconstruction of two large adjacent pulps with satisfactory functional and aesthetic outcomes. Key words: Ulnar artery perforator flap; Proper palmar digital artery; Finger injuries; Reconstruction fo sensate

El cerdo criollo es un recurso genético olvidado, que actualmente se encuentra sumamente amenazado por el mestizaje de su material genético con diferentes razas especializadas. Con el objetivo de realizar su caracterización morfométrica, faneróptica, la relación de variables con el sexo y la edad e identifi cación de biotipos, se realizó el presente estudio, evaluándose un total de 36 machos y 57 hembras en el municipio de Nueva Guinea. Se determinó la edad y 12 medidas morfológicas a partir de las cuales se calcularon 7 índices zoométricos: cefálico (ICF), proporcionalidad (IPD), corporal (ICP), profundidad relativa de pecho (IPRP), torácico (ITO), pelviano (IPV), metacarpo torácico (IMT), y las características fanerópticas en cada uno de los individuos. Del análisis estadístico descriptivo se observó que las medidas zoométricas evaluadas presentaron un rango de variación entre 13.24 % (LK) y 30.68% (DDE), reflejando que se trata de individuos con una alta variabilidad morfoestructural. El análisis de regresión reveló que todas las medidas corporales están relacionadas signifi cativamente con la edad, no así con la variable sexo que solo presento relación positiva con cinco variables y en el total de los casos no son signifi cativas. Respecto a los índices zoométricos, estos cerdos pueden caracterizarse como dolicocéfalos (ICE = 42.51), longilíneos (ICO=98.75) y convexilíneos (IPE), con un tronco relativamente profundo e intermedio entre lo elíptico y lo cilíndrico, refl ejando valores de índice torácico coincidente con su condición de longilíneos. En las características fanerópticas, se destaca que en estos cerdos predominan las capas y mucosas negras, cuerpo con abundante pelo, ausencia de mamelas y sindactilia, con predominio de perfi les rectos. Por el análisis clúster se clasificaron cuatro grupo de animales que presentaron diferencias signifi cativas entre cada una de las variables morfométricas evaluadas. Los resultados obtenidos desprenden que se trata de individuos con alta variabilidad morfoestructural y por lo tanto es difícil hacer una tipificación zoométrica de la raza, y por otro lado que los grupos de individuos diferenciados por cluster, aun y cuando presentan diferencias estadísticamente signifi cativas entre las distintas variables, no pueden ser considerados como biotipos diferenciados genéticamente, sino consecuencia del ambiente, necesitando de un tratamiento a nivel molecular y no simplemente basado en medidas zootécnicas.

Objective To explore the indications of simple syndactyly release without skin graft by analyzing the tension of skin in each segment. Methods In 38 cases of syndactyly release without skin flap, the tension of the fused skin was assessed segmentally. The relationship between the skin tension and the postoperative complications was analyzed to deduct the indications of simple syndactyly release without skin graft. These indication criteria were then applied to 10 finger webs in congenital syndactyly to verify the feasibility of these indications. Results Retrospective analysis of 38 cases showed skin necrosis at the distal phalange in 2 cases that resulted in nail deformities, and sunken lateral nail fold in 1 case. The above 3 cases were proven to be unsuitable for syndactyly release without skin graft according to our skin tension criteria. The 10 prospective cases which were performed with or without skin grafting based on the skin tension criteria all had satisfactory function and appearance. Conclusion Preoperative evaluation of the tension of the fused skin segmentally could predict the indication of skin graft in syndactyly release and guide the surgical design. Key words: Hand deformities,congenital; Syndactyly; Skin tension assessment

Objective To analyze the dynamic changes of perinatal defects in Lishui city from 2005 to 2014. Methods According to hospital-based data, 87 294 fetuses and infants aged from 28 weeks of gestation to 7 days after birth were monitored for birth defects in Lishui city from 2005 to 2014. Results Among 87 294 perinatal infants, birth defects were found in 1 914 cases with a incidence of birth defects of 219.3/ten thousand, which was on the rise year by year except 2009. The incidence of birth defects was 235.1/ten thousand (737/31 352) in urban areas, which was significantly higher than that in rural areas (210.4/ten thousand, 1 177/55 942) (χ2=5.705, P 0.05). Among 1 914 cases of defects, 657 were detected prenatally and 1 257 case were detected within 7 days after birth. Congenital heart disease was the most common birth defect, followed by polydactyly, cleft lip, microtia and syndactyly. Birth defect accounted for 32.74% (278/849) of all perinatal deaths and the ratio was on the rise since 2010. Conclusion There is an upward trend in incidence of birth defects in Lishui city in the last decade; the incidence of birth defects in urban areas is significantly higher than that in rural areas; the incidence of congenital heart disease is high, and birth defects are the main cause of perinatal death. Key words: Congenital abnormalities; Perinatal period; Incidence; Cross-sectional studies

Background: Congenital limb defects (CLDs) are a significant cause of morbidity and depending upon the severity, result in varying degrees of disability. Data on CLDs is scarce for South Asian populations. Objective: To obtain insight into the spectrum of CLDs in the population of the interior Sindh region Pakistan. Methods: A cross-sectional study was conducted in seven districts of interior Sindh and individuals or families were recruited from various hospitals and through door-to-door surveys. Results: We recruited 165 independent individuals or families with certain type of CLDs during 2010–2013. The CLDs were categorized into 10 broad categories, and the five major types witnessed were: polydactyly, syndactyly, reduction deformities, musculoskeletal defects, and brachydactyly. CLDs depicted great phenotypic variability, but collectively, upper limbs were more commonly involved than lower limbs, right arms more than the left, left legs more than the right, and distal limb segments more than proximal segments. The pattern of malformations was not different between Muslims and Hindus. Conclusions: These data established detailed distributions of CLDs across the vital sociodemographic attributes of the studied population, and are helpful in quantifying the impact of CLDs on the study population. Future molecular analyses of this cohort are anticipated to improve the clinical classifications and would also be of tremendous help to the affected individuals or families in risk estimation and genetic counseling.

To investigate the application of the dorsal metacarpal perforator sliding flap for web-space reconstruction in congenital syndactyly. According to the size and shape of skin defect at the web space after division operation of syndactyly, the corresponding intermetacarpal perforator sliding flap was designed. The edge of the flap was cut off, but its underlying tissue was not dissected. From May 2007 to November 2012, 28 web-spaces in 15 patients with syndactyly (10 male and 5 female) were reconstructed. All the 28 flaps survived completely. The flap size ranged from 3 cm x 2 cm to 1.5 cm x 1.0 cm. 14 cases with 26 flaps were followed up for 10-22 months (average, 14.5 month). The reconstructed web spaces had normal appearance and movement range. The 2-point discrimination distance was 9-13 mm (average, 11 mm). According to the Swanson Standard, 18 fingers were graded as excellent, 8 as good and 2 as fair (excellent and good, 92.6%, 26/28). Reconstruction of web-space in syndactyly with the dorsal metacarpal perforator flap has the advantages of easy handling, good cosmetic and functional results.

To investigate difference between the appearance and the bony structure in the polysyndactyly of the fifth toe fused with the fourth toe. From Jan. 2009 to Jan. 2014, 54 patients (65 feet) with polysyndactyly of the fifth toe fused with the fourth toe were treated. The appearance, X-ray and intraoperative finding were recorded and compared to classify the deformity. Then the extra toe was excised and syndactyly was separated. The malalignment and brachydactyly of the sixth toes were corrected simultaneously. According to the bone and joint type, the fifth toes were neoplastic toes without joints in 17 feet, or had poor bony and joint alignment with the sixth toes in 48 feet. So the fifth toes were excised in all the cases. The patients were followed up for 1 month to 4 years. The oblique deformity of sixth toes were corrected completely with improved length. The polysyndactyly of the fifth toe fused with the fourth toe should be classified to design the excised toe (usually fifth toe) and correction procedure. The appearance and bony joint recovery are both important.

Objective To analyze and summarize the X-ray characteristics of upper limb bone and joint in 22 cases of Poland syndrome,and explore the clinical significance of these findings.Methods The following parameters were measured on X-ray films of bilateral upper limb of 22 patients with Poland syndrome:upper limbs length,radius length,ulna length,humerus length,length and width of the capitate,length and width of proximal phalanx of the thumb,length,width and morphology of middle phalanx of the long finger,and the number of carpal bone ossification center.Statistical analysis was carried out to compare findings from various zones.Results The incidence of involvement was higher on the right side (68.18 ％) than on the left side (31.82％).More males (81.82％) were affected than females (18.18 ％).Bony syndactyly did not occur in any of the cases.Absence of the third middle phalangeal bone was a general phenomenon,indicating the severe involvement of the central column skeleton.Abnormal changes of thumb proximal phalanx and the capitate were obvious.Statistical analysis showed significant individual differences.The humerus,ulna,and radius were all shorter.Conclusion In Poland syndrome upper limb bone and joint changes mainly occur in the short tubular bones of the hand,which appear to be smaller or absent.Upper extremity long tubular bones are shorter.There is also arrested carpal bone development. Key words: Hand deformities, congenital; X-rays; Poland syndrome; Measurement

To explore the clinical effect of using dorsal two wing-shaped flap to reconstruct finger web for treatment of congenital syndactyly. This technique has been used in 19 children with congenital syndactyly. At the dorsum, a flap with V-shaped tip and two wing-shaped pedicle were designed and was just sewed up with an anchor-shaped incision at the palm. The web was primarily reconstructed without skin graft at base of fingers. Distal end of fingers were separated by using serrated flap and were closed after removal of fatty tissue. At some cases with tight skin connection. The defect area at lateral and distal end of fingers was closed by small pieces of skin graft. All the webs were reconstructed primarily without skin graft at the base of fingers. 7 cases with tight skin connection had small pieces of skin graft at lateral and distal end of fingers. Primary healing was achieved in all cases. After 1 to 6 months of follow-up, both the appearance and function were satisfactory without conspicuous scar. The reconstructed finger webs were in normal depth and width. Primary web space can be achieved by dorsal two wing-shaped flap without skin graft at base of fingers. It is one of the best choices for treatment of congenital syndactyly.

Objective To analyze the morphologic characteristic of hand and foot deformities in Apert syndrome and explore the treatment strategy.Methods Twelve cases with Apert syndrome diagnosed and treated from May 2007 to August 2012 were retrospectively reviewed.Based on the severity and extent of finger (toe) syndactyly,the authors extended Upton's classification.Deformities of the hand were classified into type Ⅰ,type Ⅱ,type Ⅲ,type Ⅳ and type Ⅴ,while those of the foot into type Ⅰ and type Ⅱ.Under the guidance of the new classification,separation of the digits were performed by one-stage procedure in type Ⅰ and by multi-stage procedures in type Ⅱ,type Ⅲ,type Ⅳ and type Ⅴ.Deviated thumbs were corrected by proximal phalangeal osteotomies.Digit separation and osteotomy were done simultaneously in type Ⅰ,Ⅱ and Ⅲ cases.For type Ⅳ and Ⅴ cases,osteotomy and digit separation were done in two stages.Complete separation of the digits and proximal phalangeal osteotomy of the thumb were accomplished in 4 patients of hand deformities.Six patients are still in the different stages of surgical intervention,while 2 patients remain untreated.Complete separation of the toes was accomplished in 2 patients with foot deformities.Results All separations of the digits and toes were successful without any digit (toe) necrosis.Web adhesion occurred in 3 cases.Flexion contracture of the fingers due to scar contraction occurred in 4 fingers.The 4 patients who had completed digit separation and osteotomy were able to perform basic pinch and grasp.Function of the feet was not significantly improved.Conclusion Apert syndrome is one of the most severe deformity complex that involves the hands and feet.Surgical intervention,digit separation and osteotomy,could provide aesthetic and functional improvement of the hand.The residual anomalies still need further study and treatment to gain more aesthetic and functional improvement. Key words: Abnormalities, multiple; Apert syndrome; Syndactyly; Treatment strategy

Objective To introduce a surgical technique for web reconstruction in the treatment of congenital syndactyly of the fingers or toes.Methods Five patients (2 with toe syndactyly and 3 with finger syndactyly) were included in the study.A pentagonal flap on dorsum of the hand or foot was designed over the dorsum of the proximal phalanx of the congenital syndactyly.The axes of the two involved digits served as the borders of the flap,defining the width of the flap from the metacarpophalangeal (metatarsophalangeal) joints of one digit to the other.After multiple Z-plasty was done to separate the syndactyly,the pentagonal flap was advanced to form the web.The adjacent sides of the separated fingers were directly covered with the triangular flaps from the Z-plasty without the need of skin graft.Results All patients were follow-up for 4 months to 2 years.All the flaps survived.There was no flexion contracture of the fingers (toes).Except for one case of hypertrophic scar formation,all patients' parents were satisfied with the web depth and appearance of the digits.Conclusion Dorsal pentagonal advancement flap is a good option for web reconstruction in simple finger or toe syndactyly.It leads to good appearance and satisfactory functions.Besides,this procedure eliminates the need of skin graft thus effectively shortens the surgery time. Key words: Syndactyly; Surgical flaps; Treatment outcome; Web