The introduction of the operating microscope as a surgical tool revolutionized the treatment of peripheral nerve lesions. A new era thus began in the early 1960s, which led to a substantial improvement in the management of nerve lesions. The results of nerve grafting techniques have demonstrated that, independent of the length of the defect, lesions can be successfully bridged. The free tissue transplants with microvascular anastomosis have also opened new, rewarding possibilities for peripheral nerve reconstruction procedures, facilitating the achievement not only of satisfactory anatomical but also of satisfactory fUhctional results. In order to evaluate the state of the art and reflect retrospectively on 25 years of microneurosurgical treatment of peripheral nerves, numerous outstanding scientists and clinicosurgical physicians were invited to Hanover in order to exchange their viewpoints and experiences. An active und fruitful discussion resulted which dealt with the many aspects of anatomy, pathology, clinical and neuro physiology, diagnosis, and with the surgery and physiotherapy which constitute modern-day peripheral nerve lesion treatment. The excit ing ongoing experimental and clinical activities have led us to support the wish and idea to publish the scientific exchange which took place during the Hanover symposium. I truly believe that the articles presented in this book cover so many interesting subjects concerned with peripheral nerve lesions that the book will serve the interested and dedicated physician involved with such cases as a reference work for the basics and also provide him with the therapeutic guidelines to assist him in his daily work."

After 20 years of intense and gradual improvements in the practice of craniofacial surgery, the International Society was born in Montreal (June 1983) and I. Munro was selected as general secretary. Its first meeting was held in La Napoule (Sep tember 1985) under the chairmanship of D. Marchac. In the meantime, the Euro pean group of the Society had held a session in Stockholm (June 1985) with B. Jo hanson acting as chairman. This now belongs to the history of our specialty, as does the course organized by E. Caronni in Rome (March 1982). These four landmarks in such a short time show the lively interest in craniofacial malformations and all their correction involves: - Syndrome delineation - Evaluation of the components of the malformations - Anatomy of the malformations - Imaging and measurement - Strategies and tactics in very different syndromes - Follow-up with reference to growth patterns in patients subjected to surgery or merely kept under observation - Implications of orbitocranial procedures for routine maxillofacial surgery - The interdisciplinary approach involving pediatricians, anesthesiologists, n- rosurgeons, ophthalmologists, orthodontists and speech specialists - The theories in vogue and those revised for some of the abnormalities All this could not be resolved in a 2-day meeting and probably will not be solved in the next generation."

Pediatric Oculoplastic Surgery is the definitive text for ocular disorders and how they apply specifically to children. Addressing everything from genetic considerations, embryology and anatomy, anesthesia, dermatologic considerations, benign and malignant tumors, fetal wound healing, establishing propoer diagnosis, timing for surgical interventions and surgical procedures. This volume is an essential addition to the library of every pediatric ophthalmologist and reconstructive surgeon. The distinguished contributors have combined their surgical knowledge and experience with over 1,100 color photographs and custom illustrations to present comprehensive and readily usable information on the identification and treatment of a wide range of ocular disorders.

Sexual medicine is an interdisciplinary subject. Special knowledge of normal and disturbed sexuality is expected of general practitioners, gynecologists, dermato logists, urologists, specialists in internal medicine, neurologists, psychiatrists, and psychotherapists. Sexual dysfunctions may occur in connection with organic lesions or as psychosomatic phenomena. They are brought to the practicing physician's attention by the patient either directly or in the form of factitious symptoms. The disturbed sexual function generally causes suffering and so motivates the patient to consult a physician. Psychosomatic aspects are thus very much to the fore. In a significant number of cases, however the disturbances stem from a physical-functional handicap which not only affects the patient's general personality but also has a direct adverse effect on sexual function. The physical defect leads to disturbances of the body-image, and so can cause impairments in the sexual sphere both directly and indirectly. The diseases which result in sexual handicap and which can be treated by reconstructive surgery were examined and discussed at an international satellite symposium of experts on the occasion of the 8 th World Congress for Sexology in June 1987. The papers presented at this symposium have been collected and edited in this volume."

Obstetric fistula is as old as mankind. While the incidence has diminished progressively with better health care in Western societies, the situation has changed little in many developing countries. Fistulae of pelvic organs, often monstrous defects, still are a major complication of child-birth causing misery to uncounted young women, and if they cannot find help in one of the very few hospitals with trained specialists, they became urological cripples losing everything: family, home and job. The magnitude of the problem is illustrated by some figures given by Reginald and Catherine Hamlin-about 700 fistula patients treated each year-a total of over 10,000 cases operated upon in their fistula hospital in Addis Ababa, Ethio pia. Most of these injuries could be prevented by better health care at the village level as some studies have shown conclusively. The incidence of fistula is an indicator of the standard of health and obstetrical care. The author of this book-Obstetric Fistula-is an internationally known Australian gynaecologist who for many years has been interested in all aspects of gynaecological urology, especially urinary stress inconti nence, other forms of involuntary loss of urine, and associated gynaeco logical conditions. He has devised a number of new operations to treat pelvic defects. Robert Zacharin's interest in obstetric fistula was a con sequence of his surgical activity in developing countries."

Amidst the innumerable articles and books on plastic and reconstructive surgery, a thorough and extensive study of the history of free skin grafting was still missing. This omission has now been rectified by Dr. Klasen. This book is an expansion of a M.D. thesis, written at the State Universi- ty of Groningen, The Netherlands, and was guided by Professor A. J. C. Huffstadt, plastic surgeon, and Professor D. de Moulin, medical historian. Professor T. Gibson kindly revised the manuscript and wrote the epilogue. But, as Goethe put it: "nur ein Teil der Kunst kann gelehrt werden, der Kunstler macht das Ganze" ("only a part of the art can be taught, the artist makes the totality"). The author, Henk Klasen, is a remarkable man. As a general surgeon, he devotes all his interest and skills to traumatology and problems of phys- iology and pathophysiology in surgery. With such talents it is natural that he also works parttime as one of the coordinators ofa modern burn unit. Among his hobbies are love of antiques and old books. This historical inclination has induced him to write the present book, in which he vividly describes the development of free skin grafting in its rel- evant theoretical and practical aspects. His elaborate study has resulted in an excellent reference book which at the same time provides enjoyable reading, once again demonstrating the value of history in understanding the present. A. J. C. HUFFSTADT, M.D.

The region of the skull base was long considered a surgical barrier because of its complex anatomy. With few exceptions, the region immediately beyond the dura or bony skull base constituted a "no man's land" for the surgeon working from the other direction. A major reason for this was the high morbidity associated with operative procedures in that area using traditional dissection techniques. This situation changed with the advent of the operating microscope. Used initially by ear, nose and throat specialists for resective and reconstructive surgery of the petrous bone and parana sal sinuses, the operating microscope was later introduced in other areas, and neurosurgeons began using it in the mid-1960s. With technical equality thus established, the groundwork was laid for taking a new, systematic, and interdisciplinary approach to surgical problems of the skull base. Intensive and systematic cooperation between ear, nose and throat surgeons and neurologic surgeons had its origins in the departments of the University of Mainz bindly supported by our chairmen Prof. Dr. Dr. hc Kurt Schiirmann (Department of Neurosurgery) and Prof. Dr. W. Kley (Depart ment of Ear, Nose and Throat Diseases, Head and Neck Surgery). The experience gained from this cooperation was taught in workshops held in Hannover from 1979 to 1986, acquiring a broader interdisciplinary base through the participation of specialists from the fields of anatomy, patholo gy, neuroradiology, ophthalmology, and maxillofacial surgery.

The greater the poverty, The stronger the will. In the face of hardship, Soar, soar, soar on still WANG Bo (650-676 A.D.) In the late spring of 1958 a patient was admitted to Rui Jin Hospital with extensive burns; just minutes before he had been dexterously operating one of Shanghai's" productive converters" used in the making of steel. He resembled a mass of charcoal but was mentally alert, asserting that he must survive, not only because of the great expectations he had of life but also to con tinue working in his beloved post as first-generation steelworker in this newly liberated country. The case presented a stern challenge; faced with this man yearning both for his own life and for that of the society in which he lived, we had no way of escaping either "poverty" (in the form of our limited facilities) or hardships. However, by pooling all our efforts we were able to ensure that the patient ultimately survived the extremely tortuous course that followed, in addition to which quite good functional recovery was achieved. So began our burn unit. It was on this patient that we performed for the first time artificial hibernation (in the treatment of burns), early eschar excision, repeated autos kin cropping, and allografting. Not only were these the decisive measures which helped our patient to achieve his professed intention, but they also gradually evolved to become the characteristics of our present-day treatment.

Evaluation and Treatment of the Aging Face is the definitive source for physicians wishing to master the latest advances in facial refinement. Solely addressing the aging face, the authors - all international authorities in dermatologic surgery - have compiled instructional, practical information on basic technique, anesthetics, causes, and treatment for a wide variety of procedures, including: - factors involved in the initial patient evaluation - sunscreens and retinoids - the use of glycolic acid - chemical peels and dermabrasion - liposuction and lipotransfer - rhytidectomy and blepharoplasty - diagnosis and treatment of skin lesions of the aging face - hair replacement - treatment of aging hands - how to develop an office based cosmetic surgery center.

The scope of dermatologic surgery is so wide that inevitably a large number and variety of complications arise. Of course the majority of complications can be prevented by careful preoperative preparation, meticulous surgical technique, and proper postoperative care, but when they do occur, they can be recognized and managed with skill and competence. This book provides a valuable source of reference for the prevention, recogni tion, and management of complications in dermatologic surgery. Avoiding pro blems is at least as important as dealing with them, and so all the chapters in this book deal with both prevention and management. This book addresses dermatologic surgeons in practice or in training and to surgeons in other specialties who may be required to undertake repair of skin defects. Many ofthe authors accepted the responsibility of contributing to this work in addition to their many other obligations. For this, I am extremely grateful to them. MARwALI HARAHAP Contents Local Anesthesia and Regional Anesthesia George B. Winton ...................................................... 1 Electrodesiccation and Curettage Harvey Finkelstein and Robert Jackson. . . . . . . . . . . . . . . . . . . . . .. . . . 16 . . . . . . . ."

Circumareolar Techniques for Breast Surgery presents the technical innovations that have largely eliminated the complications of the circumareolar approach - limiting the incision to the areolar skin junction, thus avoiding scars - as applied to mastopexy in the large and small breast, reduction of the larger breast, internal breast repair of the augmented breast, for implant removal or replacement, as well as the role of liposuction. Also included are the finer points of technique, suturing, pre-surgical marking, and post-surgical dressing. With 350 illustrations, this book is a must-have source for the plastic surgeon.

ince 1985, it has been my privilege to be the Director of The - ciety of Byron Smith Fellows. During the years in which Byron SSmith was with us, his former fellows would meet at the Ame- can Academy of Ophthalmology's annual meeting. They would present to him, and to one another, interesting cases of their own compli- tions that had occurred or cases that had been sent to them that were complications to be repaired. This forum provided the fellows with an excellent format for evaluating their own problems and also for d- cussing how to treat extremely difficult cases. Shortly after Dr. Brian Brazzo completed his fellowship with me in 1998, he asked if I thought it would be appropriate for him to edit a new book on complications of ophthalmic plastic surgery. Certainly, during his fellowship, it became apparent that Dr. Brazzo was pr- ably the most gifted academician and writer that I had ever had the pleasure of training and meeting. I could think of no one more - propriate to continue the work initiated by Dr. Byron Smith and c- ried on by his students.

Sexology as a discipline has had to fight for full-fledged recognition in the scientific community. Yet special knowledge of normal and disturbed sexual behavior is expected of medical professionals, psychologists and educators alike. Based on the papers given at the 8th World Congress for Sexology in 1987, this volume gives an up-to-date discussion of the most interesting and controversial topics, such as AIDS, in the field. Contributions have been grouped under the main headings: Family Planning, Sterility and Sexuality, Erectile Dysfunction, Sexuality in the Elderly and in Marriage, Transsexualism, Sexual Therapy, and Sexuality and Illness, and include items of historical interest as well as transcultural comparisons.

A number of vital therapeutic modalities are not covered adequately in current dermatology textbooks. This book is intended to fill that gap. It originated in a series of special lectures on modem applications of physical modalities given at recent annual meetings of the American Academy of Dermatology; the main topics were radiotherapy, electrosurgery, phototherapy, cryosurgery, and related therapeutic modalities. The authors, recognized authorities in their field, have included much addi tional information which could not be covered in the original lectures because of time limitations. The indications for modem dermatological x-ray therapy reflect the basic views of the recently published guide lines of the National Academy of Sciences-National Research Council. Both text and illustrations are oriented toward the practical aspects of therapy with physical modalities. A special effort was made to bring the contributions up to date; pertinent references have been added for those who wish to pursue particular topics still further. Where there is an apparent overlap between chapters, it was felt to be advantageous because different authors approached their subject from different perspectives. I am most grateful to the various authors who generously contributed despite their many other commitments. I wish, also, to thank the staff of Springer-Verlag for their advice and assistance in the preparation of the manuscript."

This volume is dedicated to the Third International Symposium on Microneurosurgical Anastomoses for Cerebral Ischemia, which took place in Rottach-Egern, June 2&-30, 1976, under the sponsorship of Professor F. Marguth, Director of the Depart- ment of Neurosurgery, Ludwig-Maximilians-University of Munich (West Germany). It contains the continuing devel- opments of the extra- intracranial arterial bypass (EIAB) for cerebrovascular occlusive disease since the First International Symposium in Lorna Linda, California, in June, 1973, and the Second International Symposium in Chicago, Illinois, in June, 1974. The EIAB was developed by Donaghy and Yasargil, and it consists of a microsurgical anastomosis of the superficial tem- poral artery or the occipi tal branch of the external carotid artery to the middle cerebral artery on the surface of the brain and, very recently, the anastomosis of the occipital artery to the posterior-inferior cerebellar artery for the treatment of verte- brobasilar insufficiency. From the presentations at the sym- posium it became evident that the greatest potential in the pre- vention of a stroke in a susceptible patient is the presence of an adequate collateral cerebral blood flow. The basic diagnostic procedure is cerebral angiography in- cluding both carotid and vertebral arteries. Regional cerebral blood flow (rCBF) studies and computerized tomography add further diagnostic information and are particularly important in the selection of potential surgical candidates.

This is the new edition of the concise but comprehensive handbook that should be owned by all surgical trainees specialising in plastic surgery. Taking a pithy systematic approach, Key Notes on Plastic Surgery offers the latest developments within the field in bullet point form and includes key papers for viva voces. It is informed by the current FRCS (Plast) curriculum, making it ideal preparation for the UK exit examination or equivalent international board exam. Key features * Fully covers the entire scope of plastic surgery * Clearly divided into 10 sections with logical subheadings for easy fact-finding * Acts as an adjunct to the established longer texts * Brand new chapter on ethics and the law a compulsory component of the oral examination * Illustrations outlining key surgical procedures and relevant anatomy Fully revised to include all the latest clinical guidelines, Key Notes on Plastic Surgery is the perfect rapid reference tool for trainees in plastic surgery and dermatologic surgery who require quick, accurate answers.

Reconstructive microvascular surgery is now in its teens. At first many thought this new child was a whim and would fail to thrive. Some were un certain, others with vision either supported or became actively involved in this new area of surgical endeavour. Although initial interest was focused on the replantation of amputated parts, it has been the one stage free trans fer of living tissue to a distant site which has launched microsurgery into the surgical spotlight. From its humble beginnings we have witnessed a revolution in this branch of plastic surgery; many of the long established methods of recon struction have, like barricades, fallen before the advances made in this field. In its infancy there were relatively few procedures available. There was a tendency to make the patient's problem fit the operation, rather than the reverse, and this frequently led to an inferior result. The then known flaps, such as the groin flap and the deltopectoral flap, were employed. Unfortunately they were sites which posed many technical problems; namely those of vascular anomaly, a short pedicle and vessels of small cal ibre. Long operations were the norm, and vascular thrombosis was not un common. Hospital routine often was disrupted and there was a danger that these new techniques would fall into disrepute. Over the last decade this state of affairs has changed dramatically.

Distraction osteogenesis is a technique of bone lengthening developed by the late Dr. Ilizarov of Russia. It has been applied to the lower extremities with amazing success for the correction of non-unions following fractures as well as underdeveloped limbs. Dr. McCarthy and his colleagues at NYU have developed techniques of distracting various components of the craniofacial skeleton. These techniques hold considerable promise for reconstructive surgery, allowing the surgeon to make precise changes in the lenthening and shape of the new craniofacial bone. This volume is the first book of its kind, bringing together the pioneers of these revolutionary new techniques. An international group of experts present their clinical and laboratory experience with destraction of the cranial vault, orbit, midface and zygoma, and mandible, as well as the prinicples of distraction, biomechanics, and the physiology of bone healing and remodeling. Two hundred illustrations elucidate the techniques. This book is a must for all reconstructive plastic surgeons, maxillofacial surgeons, and oral surgeons.

Several years ago Coleman (1981) reported that in 1979 one of the many in ternational cosmetics companies had an annual sales figure of $2. 38 billion, nearly 1. 25 million sales representatives, and over 700 products, the majority of these being for the face. Cash and Cash (1982) noted that in 1979 U. S. consumers spent over $4 million on cosmetic products. They stated that, "Although this practice would seem to be a fascinating aspect of human be havior on the basis of its generality and resilience, social-behavioral scientists have largely ignored the phenomenon so plainly (or pleasingly) in front of their eyes. " Why should people be so concerned with their facial appearance? Many psychologists have argued (e. g., Kleck & Rubenstein, 1975) not only that facial information is usually the first that is available to the perceiver, but also that it is continuously available during social interaction. Maruyama and Miller (1981) stated that "appearance is often the first dimension upon which a stranger can be evaluated. Since people tend to see others as integrated and consistent units, rather than as collections of situation-specific behaviors, a potent and immediately evident basis for an evaluation, such as physical appearance, should intrude into and affect any overall and subsequent evalua tion."

For many years, the operative manipulation of the most minute struc- tures was frustrated by the limitations of the human eye. With the introduction of the operating microscope by Nylen (1921), fine detailed anatomy was made visible, so that structures could be prepared, pre- sented and manipulated. Nylen used the microscope for treating dis- eases of the middle ear. In 1946 Perrit in the U. S. A. introduced the operating microscope into the field of ophthalmic surgery. In 1964, Smith, Kunze and Mitchen published reports on their clinical experi- ence using the operating microscope in nerve surgery. Using this tech- nique, it was possible to divide a peripheral nerve into individual fascicle bundles and reapir each bundle precisely. Following on from these developments, the term" microsurgery" was introduced to cover that branch of surgery which was carried out using the" equiped" eye - either by using 10upe spectacle magnifica- tion or, more commonly, the operating microscope. The term "micro- vascular surgery" developed for the operative treatment of small ves- sels below 2 mm in diameter. Experimental studies for the use of microsurgery in the clinical situation developed alongside its use on small research animals for transplantation models in immunological study. Microsurgical techniques were used in the transplantation of rat liver, kidneys, pancreas, heart and other organs. The clinical appli- cation of these microsurgical techniques is nowadays called "recon- structive microvascular surgery".

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.

In 1958;a severely burned steel worker, the extent of whose bums was 890/0 of the body surface, with 20070 of third degree bums, was saved by the Kwangts'e hospital (now the Rui Jin hospital) of Shanghai Second Medical College. It was the first report in the world of such a critically injured patient recovering, and seemed like a miracle at that time. During the 24 following years, a great number of papers reporting the development and advances in bum therapy in clinics and in research showed that Chinese medical investigations in the field of bums have ranked among the most advanced in the world. Plastic surgery, as an independent branch of general surgery, has been established gradually since Liberation. Recently, new techniques, including microsurgical techniques, in plastic surgery have emerged and developed, permitting rapid progress in clinical work and attracting attention and appreciation in other parts of the world. The first national congress of Burns and Plastic Surgery was held from May 16-24 1982 in Shanghai. Over 800 papers were presented and showed how advances have been made in recent years in these two specialities. Here we present selected articles as a symposium. It is hoped that this symposium will be of value to its readers. About the Editors Chang Ti-sheng (Zhang Di-sheng), who was born 12 June 1916, is Professor of Surgery, Shanghai Second Medical College, Shanghai, Chief of the Department of Plastic and Reconstructive Surgery, and Director of Shanghai Ninth People's Hospital, Shanghai.

Preclinical experimental transplantation research that is based on microsurgical models in rats fulfills two indispensable conditions for modern organ transplanta tion research: Almost all organ grafts can be performed on the rat with an amount of technical effort that is still justifiable. Thus transplantation models that are analogous to human organ transplantation can be developed, tested, and evaluated. This fulfills a necessary condition from the standpoint of surgery. With the species rat, we have a great variety of genetically different inbred strains. From the immunological point of view this is an indispensable prerequisite for the investigation of preclinical transplantation models that can be expected to produce controllable, reproducible results. In vivo experimental results can be supplemented by and correlated to in vitro tests. Lately these experimental results are being greatly expanded and more precisely defined by the application of immunohistological methods that have been established recently in Kiel. In this book we hope to present a cross section of the microsurgical models in use today and of current immunological and immunohistological models. Furthermore, we wish to record the present state of microsurgical organ transplantation research and to show its relationship to the current state and development of clinical organ transplantation. A special aspect of our Kiel research group is the long-term, well-functioning, interdisciplinary cooperation between surgery, immunology, and pathology. Through this cooperation we attempt to provide an atmosphere in which theoretical and practical viewpoints can mutually influence each other."

This book has been assembled from the radiographic and photo graphic records of patients presenting to craniofacial units on four continents over 7 years. It is our purpose to illustrate a wide range of craniofacial deformities with the technique of three-dimensional com puted tomography. Many topics are briefly addressed with descriptive text intended to amplify the accompanying images but not to exclude the need for more comprehensive references as recommended in the reading list of each chapter. The ability to generate three-dimensional radiographic images rep resents a successful integration of computed tomography with com puter graphics. Although this technique remains an electronic substi tute for the study of dry skull specimens, it offers a permanent pictorial record of anatomical structures with the opportunity for fu ture interactive data manipulation. It is hoped, therefore, that this work will assist others to gain a more complete understanding of disorders of the craniofacial region. We encourage other surgeons and investigators to examine and employ the techniques used to gather these images but also to ensure that standardized scanning regimens are adapted. The importance of data collection within its full anatomical context was borne out with many of our early studies, which were limited owing to computational con straints. Often an image requirement for surgical intervention is much less than an image necessary for strict scientific inquiry."

Endoscopic Techniques in Plastic and Aesthetic Surgery comprehensively addresses both the aesthetic and reconstructive aspects of endoscopic surgery as applied to plastic surgery. The editors, renowned pioneers of these techniques, have assembled a group of distinguished contributors to present, step-by-step, the operative strategies for incorporation of endoscopic procedures to the armamentarium of the practicing plastic surgeon. The procedures are precisely and exquisitely rendered by 721 illustrations, including over 300 full color endoscopic views and operative photographs. This book is the essential, definitive source for mastery of these state-of-the-art techniques.