This volume contains the proceedings of the Symposion on Shoulder Joint Replace ment held at the Kieler Yacht Club in conjunction with the 35th Annual Meeting of the Northwest German Orthopaedic Surgeons at Kiel in 1985. Since the advent of suitable implant materials hemiarthroplasty of the shoulder was explored in the 1950s; total shoulder joint replacement was first reported in 1971. As interest in solutions to problems of the shoulder is growing, it appeared timely to present to interested clinicians the possibilities and limitations of a proce dure as seen after nearly two decades of trials and experience. This volume is meant to give a comprehensive overview of the bases, the development, the alternatives, the state ofthe art and, an outlook on some future trends. The number of patients with problems warranting shoulder arthroplasty is rela tively small. We consider this a blessing. This may be the reason why the number of surgeons who ventured in this field has remained small, even after implants became available - testimony of an awareness, that shoulder surgery is difficult. The editors consider themselves fortunate to have been able to call on a number of those individuals, who were involved in first trials and in their evaluation. The editors are especially indebted to those from overseas who took it upon themselves to come, share their experience and join in the discussion."

The first edition of Surgery of the Hip Joint has had certain measures of success. Its cover won the Outstanding A ward for art at a publishers trade show. A year later it was translated into Spanish for exposure to the vast world of the Spanish speaking peoples. As I traveled through Europe, it was repeatedly a pleasant surprise to have the book recognized as an authoritative reference. This was a great tribute to the experts whose diligent efforts made it all possible. Apparently the book has stood the test of time to judge from the many inquiries and constructive comments made toward urging us on to write a second edition. It was not an easy task to gather another cadre of authorities to update our knowledge of the hip joint. People who have earned respected positions in their field are unavoidably burdened with a busy schedule, so a chapter in this text must be appreciated as coming from someone devoted to giving up some of his precious time for the sake of sharing his knowledge with peers and students. As we struggled along, it became obvious that the book should be divided into three volumes, because outdated concepts had to be scrapped if an up-to-date text were to be offered. Time passed so rapidly that total hip arthroplasties would not become stabilized because of a never-ending parade of implant designs with increasing bioengineering considerations.

In thc space of ooly a few years, reconstructive surgery of the skeleton of the hand has become a foeus of attention. Thc reason for this has been the advent of principles and techniques of stable internal fixation, tbc unparaJleled advantages of which are particularly evident in the treatment of the complex, multi- structural lesions so typical of injuries of the hand, and also in procedures such as replantation or revascularisatioss. What a striking contrast on the other hand is to be seen in the slow and painful progress made in Dur understanding of the biomechanics of the radiocarpal joint! This is most elo- quently ilIustrated by the embryonie state of prosthetic surgery of the wrist, compared with the sophisticatcd advances made in hip and knee surgery. Yet it is undeniable that painful condi- tions involving dysfunctions of the wrist are increasing in number and affect young people in particular; this should spur us on to seek more effective therapeutic solutions.

and refinement that exists within the necessarily strict rules of the internal fixation method. In this way we seek to contribute to as weIl as to stimulate the search for rational solutions to surgical problems. It is assumed throughout that the reader is fa miliar with the technical fundamentals of internal fixation, and so these details are omitted. Instead, special indications and technical refinements are presented on the basis of case examples. Because an endless variety of situations can arise in orthopedic surgery (a circumstance that is attracting more and more surgeons to the field), we have taken ca re that our examples can readily be applied to novel situations. We now credit, in alphabetic order, those who contributed most to the techniques presented: R. BLATTER, A. BOITZY, C. BRUNNER, O. CECH, A. DEBRUNNER, F. MAGERL, G. SEGMUELLER, G. STUEHMER, and B.G. WEBER. We thus express thanks to those colleagues in our clinic who agreed to having their ideas published. But we are also grateful to our illustrators, H. and K. SCHUMACHER, our photographer, M. SCHAFFNER, and our chief secretary, U. OETLIKER, who contributed so much to the preparation of the manuscript. Finally, we thank Springer-Verlag for their patience with us and especiaUy for their efficient work in bringing the book to press. St. GaU, Fall 1981 CH.F. BRUNNER B.G. WEBER Contents Lag Screws ............. .

Severe spondylolisthesis/spondyloptosis is still a controversial issue in spine surgery. This book takes an interdisciplinary approach and discusses the state of the art and defines therapeutic strategies. The contributing authors are well-known specialists in the field.

This volume is the work product of an international group of authors who are experienced in the field of musculoskeletal allografts. The chapters are written by experts in many differing areas of allografting and represents the current knowledge in this rapidly changing dynamic field. The reconstructive community and their patients owe a significant debt of gratitude to Doctors Czitrom and Winkler for this volume. William F. Enneking, M. D. Preface What follows is the result of a timely project bringing together the newest ideas of top experts worldwide in a rapidly growing technology: Orthopaedic Allograft Surgery. The title of the book reflects a method rather than a speciality. It transgresses well established subspecialities of orthopaedic surgery such as joint replacement, oncology, spine, trauma and sports medicine. The technology encompasses knowledge of tissue banking, biology and biomechanics, both in a research and clinical sense. The common denominator for those interested is the need and ability to provide or use allogeneic tissues in orthopaedic applications. Inherent to a multiauthored text based on chapters written by authors from many parts of the world is a variety in format and style. While we tried to some extent reducing large discrepancies, there was no attempt made to eliminate dissimilar ities. We did not aim for a homogeneous textbook. Rather, we asked for originality, novelty, individuality in the presentation of data and concepts. Consequently, chapters vary in format from that seen in a scientific article to that of a descriptive essay."

In this updated edition of the German-language title "Neue Techniken - Kniechirugie", Professor Paessler, an experienced knee surgeon, provides a state-of-the-art survey of the field. In doing so he describes, among other techniques, how to reconstruct the anterior cruciate ligament (ACL), perform ACL revision surgery, manage a recent posterior cruciate ligament tear, treat cartilage lesions with microfracturing, reattach/replace detached cartilage fragment, perform a dome high tibial osteotomy. Professor Paessler is author of more than 150 publications (books and journals) and editor-in-chief of the "European Journal of Sports Traumatology and Related Research". An important resource for all trauma and orthopaedic surgeons and trainees.

Information is provided from the basic and clinical sciences on the mechanisms damaging the brain from trauma or ischemia. New aspects involve the endoplasmic reticulum, mitochondrial failure, pathobiology of axonal injury, molecular signals activating glial elements, or the emerging therapeutical role of neurotrophins. Experimental issues involve a better analysis of the ischemic penumbra, the salvagable tissue. Therapeutic contributions reach from the environmental influence to gene expression, including neuroprotection, such as hibernation - mother nature's experiment - or hypothermia which is reported to induce cell swelling. Treatment issues deal also with thrombolysis and combination therapies, or with the clearance of adverse blood components - LDL/fibrinogen - by a novel procedure using heparin. Other highlights are discussing the specificities of pediatric vs. adult brain trauma, or the evolving role of the Apolipoprotein-E e4 gene in severe head injury. An update is also provided on an online assessment of the patient management during the pre- and early hospital phase in Southern Bavaria. The empirical observation of neuroworsening is analyzed in further details, whether this is a specificity autonomously driving the posttraumatic course. Finally, the unsolved question why drug trials in severe head injury have failed so far in view of the promising evidence from the laboratory is subjected to an expert analysis.

"When a thing ceases to be a subject of controversy, it ceases to be a subject of interest. " WILLIAM HAZLITT (1778-1830) This is the fourth volume in a series which we started in 1997. In 1976, Varco and Delaney edited a "surgical bestseller" entitled Controversy in Surgery. This was fol lowed by a second volume in 1985. The immense success of these books among both surgical trainees and experienced surgeons, and their wide international ap peal, supported the editors' notion that a view of controversy is integral to teach ing. However, despite major advances in surgical science and practice, no other similar publication has since been put together with the objective of addressing major controversies in surgery. The aim of this series is to address such deficiency by covering the most crucial current controversies in general, vascular and trauma surgery. Since almost everything is controversial in surgery, we will be able to tackle different issues almost each year. The editors have selected a nationally/internationally recognized authority for each topic. Most books available today are either "North American: ' "British-Com monwealth" or "British-European: ' contributing to the constant transatlantic rival ry. Our series specifically aims to bridge this "culture gap" and includes North American, British, European, and other authors while maintaining a cohesive structure. This will hopefully also broaden the appeal of such a book across both sides of the Atlantic and beyond."

Progress in traumatology of the vertebral spine has been restrained for a long time by two hindering factors. The first obstacle is presented by the differences in approach and a conflict of competences. The neurosurgeons, considering only the spinal chord, have confined themselves to indications for laminectomy, an insufficient and usually ineffective intervention. The orthopedic surgeons, on the other hand, obsessed by the fear of medullary lesions, have long hesitated to apply the fundamental rules for the treatment of fractures, namely precise reduction followed by strict immobilization, thus depriving themselves of the efficacy of radiculomedul lar decompression and of the protection this procedure affords to these structures when they are themselves involved in the trauma. Taking these facts into account, together with the rather poor results of laminectomy, the specialists have wisely and successfully recommended that one should abstain from treating the initial lesion, but rather attenuate the damage by appropiate nursing care and adequate reeducation. The second hindering factor was the insufficient knowledge of the extreme complexity of the anatomic lesions. This explains the orthopedists' relative caution; one only treats well what one knows well. More precise analysis of the lesions, not only of the bones but also of the joints, i. e., the osteofibrous involvement, is mainly based on strict radiologic semiology, which is rendered difficult because these structures are simultaneously affected. We are greatly indebted to Dr. DOSCH, radiologist at our Center, for having untertaken this difficult task, using all available conventional radiologic techniques."

The second common meeting of the European Section and the Cervical Spine Research Society took place in Marseille (France) from June 12 to 15, 1988 and was organized by Rene Louis. More than 130 specialists from every part of Europe, from America and Asia participated, representing, among others, the fields of Orthopedics, Neurosurgery, Traumatology, Neurology, Anatomy, Rheumatology and Radiology. This meeting again was convincing proof of the growing interest which exists in Europe in research into injuries and diseases of the cervical spine. The main topics of this meeting were the subluxation of the lower cervical spine (chapter 1) and the infectious diseases of the cervical spine (chapter 2). Chapters 3 and 4 of this volume deal with degenerative lesions and the upper cervical spine. In chapter 5 experimental reports are presented, so that a good synopsis is provided of our present state of knowledge of diseases of the cervical spine. The European Section of the Cervical Spine Research Society was founded by Mario Boni in 1984, who unfortunately died in 1986 and was proclaimed Honory President of the European Section. There is a European meeting every summer and one every three years with our colleagues from the United States of America, Canada and Japan organized in Europe. The first combined meeting was organized by Pierre Kehr in Strasbourg (France) in 1985 and the presented papers were published in Cervical Spine I (Springer, Wien-New York, 1987).

It is with pleasure that we offer these introductory remarks for the Manual of Internal Fixation in the Horse, a book describing a further application of AO or ASIF techniques. The letters A-O stand for the Arbeitsgemeinschaft fUr Osteosynthesefragen and have been trans lated into the Association for the Study of Internal Fixation. The organization is truly a "study group," created in Switzerland, that met for the first time in 1958. The major goal was to establish a task of fracture treatment by force committed to the improvement osteosynthesis. The group's motivation arose out of the then prevailing unsound or inconsistently successful attempts at fracture treatment. According to statistics obtained from the Swiss National Health Insurance Program at the time, the so-called conservative treatment of fractures had resulted in a high rate of persistent morbidity. The problems encoun tered included: irreparable damage due to long-term immobilization; delayed union or pseudoarthrosis; malalignment; and, inadequate reduction of intraarticular fractures with resultant osteoarthritis. Accurate, stable osteosynthesis seemed the only practical way to address those various shortcomings. However, many of the osteosyn theses performed at that time had led to new problems, since most were not stable and, in some cases, actually worked to prevent healing."

This book is the result of an international symposium on bone transplantation, the first of its kind, held in Berne, Switzerland, on May 14-16, 1987. This symposium brought together some of the most outstanding experts - from all over the world, principally from North America and Europe -in the clinical bone transplantation and in basic research. It was an unique opportunity to summarize in a few days the state of the art in this field and to bring clinicians who carry out some research related to their work together with basic scientists. The clinician can on the one hand profit from the basis researcher's knowledge and on the other stimulate the researcher to share the orthopedic surgeon's interest in osteo articular allografts. The book, like the symposium, contains two types of contributions: 1. Papers from invited experts who have often dedicated a significant part of their professional life to the subject of bone transplantation. Knowledge which would otherwise be scattered among original papers from many different sources, some of it less firmly established and therefore less well known, is thus collected together in one volume, so that the reader does not have to weed out a mass ofless important material. These chapters may for a certain time act as a textbook on bone transplantation, but inevitably will eventually be superseded by new findings. 2. Descriptions of current research in all the main subjects covered in the state of-the-art papers."

Percutaneous lumbar discectomy is a new surgical method for treating lumbar disc diseases. The goal of the procedure is decompression of the spinal nerve root by percutaneous removal of the nucleus pulposus under local anesthesia. Probably 20 % of all patients requiring lumbar disc surgery can be successfully treated by this method. During the past two years, percutaneous discectomy has spread rapidly, and it is now performed in most clinical departments engaged in spinal surgery. The first International Symposium on Percutaneous Lumbar Discectomy, held in Berlin in August 1988, covered all current procedures known as "percutaneous discectomy" and the entire range of percutaneous techniques, both clinical and experimental. Its publication is important because of the recency of this new surgical procedure, the outstanding experience of the speakers - including the Japanese, American, and European "pioneers" of the technique - and last but not least the gaps in the knowledge of physicians concerning this topic. This procedure opens up new perspectives in the surgical treatment of degenerative diseases of the lumbar spine.

This book contains the proceedings of an historic sympo sium, the first joint symposium of the Austrian, German and Swiss Trauma Associations and the Orthopaedic Trauma Association of North America. In an effort to bring Euro pean and North American trauma surgeons closer together and foster a free and productive exchange of ideas, these associations chose the meeting of the Austrian, German, and Swiss trauma associations, which was held in Vienna in May of 1991, as the occasion for their first joint session. The Austrian Trauma Association, led by its President, Professor Heinz Kuderna, was the host. The joint symposium of the European and the North American trauma associations, conducted in English, was held concurrently with the regular meeting of the AGS, conducted in German. In order to explore and compare the current concepts in trauma on the two continents, the organizing committee felt that the discussion should focus on an area full of challenge and controversy. Thus the major fractures of the pilon, the talus, and the os calcis were chosen as the topics of discus sion. Each subject was introduced by two keynote speakers, one from Europe and one from North America, who were chosen by their respective trauma associations on the basis of their expertise and distinguished contributions. These presentations were then followed by five or six invited shorter presentations on the subject. At the end of each session, the presenters formed a panel, debated controversial points, and answered questions from the audience."

It is to the great and lasting credit of LORENZ BOHLER and his school that they have in the last decade developed and demonstrated so thoroughly the techniques for the conservative management of fractures. Nevertheless there have always been many, including some from BOHLER'S school, who have found considerable place for surgical management, and with the significant progress in general surgery seen in postwar years, a new stimulus has been given to this part of traumatic surgery, especially since bone injuries have become more complex and frequent. The concept of internal fixation is not new. The serious criticisms that have been levelled at it retain today their basic significance. Progress in the fields of asepsis, corrosion-free metal implants, operative experience and postoperative care has diminished the dangers but has not relieved the surgeon of responsibility. The Association for the Study of the Problems of Internal Fixation (AO) has devoted itself over a number of years to the basic principles and best methods of open treatment of fractures by means of extended clinical and scientific studies in order to determine in each individual case the most promising line of treatment. At the same time a well designed and tested instrument set has been developed with precise instructions for the appropriate techniques. As a result, the new observations about primary bone healing which have emerged from the practice of rigid internal fixation are as interesting as the uses to which they can be put in allowing early mobilization.

The reconstructive surgery of posttraumatic deformities has made significant advances in recent years. Reports on technical progress and clinical results are encouraging, even though they have often raised patient expectations to an unrealistic level. The operative methods available to us today enable corrective osteotomies to be performed with a high degree of accuracy and success. Precisely because the sequelae of trauma are so difficult to schematize, every case must be evaluated individually based on a critical assessment of subjective complaints, diagnosis and prognosis before a decision can be made. The planning and execution of corrective procedures are carried out with the same meticulous care as for idiopathic limb deformities. However, the occurrence of a traumatizing event with its immediate and long-term complications calls for special insight in the setting of therapeutic goals. It is essential that the patient be appraised of the results that can reasonably be expected and of the risks that are involved. Success in therapeutic procedures requires detailed theoretical knowledge, thorough operative training, and a strong commitment on the part of the surgeon. It is these aspects of the corrective surgery of posttraumatic deformities with which the editors are principally concerned.

Surgeons confronted with acute trauma are frequently under great pressure to act quickly. Only a few have an infallible three-dimensional memory as regards the different approaches necessary for treating fractures by inter nal fixation. Thus there is a real need for a reference book on the approaches to the shoulder, arm, pelvis, and leg which is instructive and based on clinical practice. This is true both for the emergency situation and for the "evening before" with the imperative preoperative planning. THOMAS RUEDI, himself a surgeon as well as a gifted illustrator, in coopera tion with ARTHUR VON HOCHSTETTER, a clinical anatomist, and excellently interpreted by the artist ROBERT SCHLUMPF, has created a novel and impres sive atlas. The surgical approaches are depicted in a manner which is ana tomically correct, limited to the essentials, and realistic. In addition, the attractive, black-and-white illustrations of the anatomy are successfully sup plemented by color schematic drawings. This luxuriously prepared edition may become a daily advisor to surgeons dealing with trauma. It deserves a widespread distribution in surgical depart ments and reference libraries.

The varus knee has a group of bone and ligament abnormalities that must be addressed to correct the deformity. The mechanical axis of the femur is tilted medially relative to the long axis of the tibia. The distal femoral surface usually remains in valgus alignment to the long axis of the femur. Most of the varus deformity is caused by deficiency in the medial tibial plateau. The deep and superficial medial collateral ligaments are contracted and deformed by osteophytes.

During their 20 years of activity members of the Associa tion for the Study of Internal Fixation (AO - ASIF) have made authoritative contributions to the development of internal and external fixation. The close collaboration of surgeons, basic researchers, metallurgists, engineers and the establishment of clinical documentation has made it possible to achieve a solid scientific basis for internal fixa tion. Clear definitions for the standardization of different types of osteosynthesis were possible: interfragmentary compression, splintage and buttressing as well as combina tions of these three techniques. At the same time a scienti fic and workmanlike instrumentation was developed. The idea was to keep diversification within limits but, however, to assemble a comprehensive collection of implants and in struments to answer all the problems presented by the com plexity of bone operations. Osteosynthesis is a difficult and demanding operative method. Its. claims on the surgeon and the theatre staff are high. Therefore plans have existed for a long time to supplement the "Manual of Internal Fixation" with a de tailed description of the AO Instrumentation, its use and maintenance. Our collaborator FRIDOLIN SEQUIN, graduate engineer, has accomplished this task with expert knowledge. He has organized over many years courses for theatre nurses and has been able from the resulting experience to provide helpful suggestions. When RIGMOR TEXHAMMAR R. N. joined AO-International four years ago, it was natural to include her as a co-author."

Edited by two leading orthopedic surgeons who are specialists in the treatment of hemophilia, Orthopedic Surgery in Patients with Hemophilia shows all the surgical techniques needed for surgical treatment of musculoskeletal complications of hemophilia. A practical guide, designed for use on the ward or in the office, this book draws on the experience of numerous specialists worldwide, from developed and developing countries. As well as orthopedic surgery, it also covers research, hematology, and rehabilitation. Although of primary interest to the orthopedic surgeon, rheumatologist, and physiotherapist, this book will also be relevant to the hematologist responsible for the care of the hemophiliac patient.

"Knee replacement is bound to fail-providing the patient lives long enough." There is some truth in this hoary cliche, so why write books on the subject? I think the answer is that knee replacement has at last become established and even respectable. The more absurd surgical extravaganzas have been recognised and discarded; today a patient can expect to rely on his new knee to serve him with comfort for a fair number of years. Of course even the early knee replacements often made the patient comfortable; the trouble was they just did not last. All too often the innovator's enthusiasm was overtaken by the patient's disillusionment. Indeed, the operation might well have been abandoned had it not been for the hope that one day the dazzling results at the hip might be matched at the knee. These pioneer prostheses were designed as though the knee were biomechanically as straightforward as the hip. Alas, numerous complexities soon became apparent; in response the models multiplied-and multiplied-until the ordinary orthopaedic practitioner became hopelessly bewildered. He found himself subjected to high pressure propaganda; from the surgeon offering a miracle cure, from the engineer seeking fame and from the manufacturer expecting fortune. Visiting his unit as a team, this trio was well-nigh irresistible.

It is interesting to observe the evolution of medical education over the years. The massive textbooks of the past have almost disappeared except as works of library reference. In their place we now find an increasing number of publications which explore the detail of particular specialities and sub-specialities. Once the young surgeon has acquired his basic knowledge of surgery in general (as it is now called), postgraduate education, whilst seeking to maintain the general scientific and humanistic principles of surgery, is forced to provide specialised reference works in a whole variety of fields, amongst which the postgraduate will choose his own future interest. This tendency emphasises the importance of the Conference on Surgery of the Shoulder organised by Professor Kessel and his colleagues. This first inter national gathering of surgeons and others in related disciplines who are interested in the disorders of the shoulder was self-funded under the aegis of the Institute of Orthopaedics and University of London, and it is to be hoped that other Universities, hospitals and medical foundations will give maximal financial and moral support for further ventures of this kind. This volume places on record the concepts and practices of those interested in the injury and disease of the shoulder joint, and thus becomes a reflection of our knowledge in this field in the second half of the twentieth century."

This monograph presents a comprehensive review of the clinical experience in surgical repair of cranial defects which the author has gained during a period of over ten years. Particular problems of patients undergoing cranioplasty, such as neurological impairments, EEG changes, variations of intracranial pressure, and sinking skin flap syndrome are described and discussed. The author presents convincing evidence of the importance of cranioplasty in improving the quality of life of patients with large and disfiguring cranial defects. Unfortunately, cranioplasty still ameliorates only to a minimal extent the general condition in patients suffering of major cerebral lesions. I am convinced that this volume will serve the purpose it was designed for : that it will be a most helpful introduction into the problems related to reconstructive surgery. Basel, August 1984 Otmar Gratzl Contents Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 A. History of Cranioplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 B. Clinical Aspects of Cranial Bone Defects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 I. Origin of Cranial Defects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 1. Acquired Defects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 2. Congenital Defects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 3. Demographic and Other Characteristics of Patients . . . . . . . . . . . . . . . . . 9 II. Neurological and Psychic Changes Before and After Cranioplasty . . . . . . . 11 1. Classification of Neurological Deficits and of the Skin Flap Types . . . . . 13 2. The "Sinking Skin Flap Syndrome" . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 3. The Influence of Cranioplasty Upon Neurological and Psychic Changes 17 III. Electroencephalographic (EEG) Changes in Patients with Cranial Defects 21 1. EEG Recordings and Casuistic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 2. Evaluation of EEG Changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 IV. Scintigraphy Findings in Patients with Cranial Bone Defects . . . . . . . . . . . . 26 1. Casuistic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 2. Results and Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

This book provides detailed guidelines to any physician treating patients with emergency vascular disorders. These might include ruptured abdominal aortic aneurysms, acute limb ischemia, vascular trauma, iatrogenic vascular injuries and complications to vascular surgery. The book provides an introduction to vascular surgical operations and focuses on how to manage patients. Numerous figures illustrate the particular points in vascular techniques and diagnostic problems in the emergency situation. This is an indispensable guide for all surgeons dealing with vascular emergencies.