In recent years wrist problems have increasingly attracted the attention of orthopaedic and hand surgeons. Numerous advances have been achieved in functional anatomy, biomechanics, diagnosis, and treatment. There are, however, many controversial aspects to these problems. Many clinical and associated investigators from around the world have attempted to increase our knowledge of the wrist with enthusiastic and devoted studies. An international symposium was held at the Nagoya Castle Hotel, Nagoya, Japan from March 6th through March 8th, 1991 to further understanding and promote discussion of wrist problems among a representive international group. Approximately 300 participants from 16 different countries assembled for these discussions. This monograph consists of 40 selected papers based on presentations given at the international symposium. The topics are divided into six chapters: Functional Anatomy, Diagnosis and Basic Studies; Kienbock's Disease; Scaphoid Fracture, Distal Radius Fracture; Carpal Instability and Wrist Pain; and Wrist Arthroplasty. A number of unique observations as well as detailed surgical techniques were presented. These include topics such as the vascularity of the triangular fibrocartilage, radial wedge osteotomy and vascular bundle implantation into the lunate for Kienbock's disease, Herbert screw insertion though a minimal exposure for acute scaphoid fracture, and closing wedge oseotomy of the radial styloid for the early stage of the SLAC wrist. It is hoped that this monograph will be of benefit to surgeons interested in not only achieving more satisfactory clinical outcomes, but also in stimulating further contemplation and research about these difficult wrist problems.

The advent in the 1960s of the unique and exciting new form of energy called laser brought to medicine a marvelous tool that could accomplish new treatments of previously untreatable disorders as well as improved treat ment of mundane problems. This brilliant form of light energy is many times more powerful than the energy of the sun yet can be focused microscopically to spot sizes as small as 30 microns. Lasers can be directed into seemingly inaccessible areas by mirrors or fiberoptic cables or can be directly applied into sensitive areas such as the retina without damage to intervening structures. There has been a rapid proliferation in the use of lasers in all surgical specialties. Starting with bold ideas and experiments of "thought leaders" in each specialty, the application of lasers has evolved into commonplace usage. Beginning with the era when laser presentations and publications were an oddity, now nearly all specialty areas have whole sections of meetings or journals devoted exclusively to laser usage. Laser specialty societies within a specialty have developed and residency training programs routinely instruct trainees in laser techniques. Basic science and clinical experimentation has supported laser knowledge. Laser usage has also become international. Newer wavelengths and accessories have added to the armamentarium of laser usage. Despite the rapid growth in laser interest, no single source exists to instruct the many new laser users in proper, safe, and effective use of this new modality."

Until now, the general belief has been that premature baldness (male pattern bald- ness: M.P.B., or androgenetie alopeeia) is a hereditary eondition that progresses with age and for which there is no eure. If the father is bald, it is assumed that the ehild may also be destined to be bald sometime in the future. The existing theory throughout the world is that the eentral portion of the hair follicle is the hair root, and hair ean never regrow if the hair root has been removed. Dr. Inaba has introdueed a new theory that the eentral portion of the hair folliele is not only the hair root but the upper isthmal portion elose to the duet opening of the sebaeeous gland. This is a totaUy new understanding of the hair growth mechanism and the hair eyele. In his experienee in the surgieal removal of the sweat glands, whieh also removes the hair root, Dr. Inaba has found inereasing evidenee that hair regrows if the sebaeeous gland is left intaet.

Discussing the most current and pioneering techniques in breast reconstruction without the use of implants, this is the volume every breast surgeon has been waiting for. Focusing not only on how to reconstruct breasts following mastectomy but also on how to achieve the highest degree of aesthetic success possible, Dr. Kroll describes in detail his techniques in using autologous tissue. Over 500 photographs and custom illustrations demonstrate and compare the different techniques used in breast reconstruction with autologous tissue such as conventional TRAM flaps, free TRAM flaps, the extended latissimus dorsi myocutaneous flap, and the Rubens fat pad free flap. Also include are chapters on immediate and delayed reconstructions, shaping the breast mound, nipple and areolar reconstruction and choice of technique, follow-up and patient selection.

In spite of great advance made by ENT and maxillofacial surgeons as well as radiotherapists to improve therapy of cancer of the oral cavity and oropharynx, it has not been possible in the past 4 decades to raise the chances of patient survival above 40%-45%. However, recent studies with different combination therapies indicate that better results can be expected in the future. In this volume, the current status and results of therapeutic studies are presented by distinguished clinicians in the three disciplines. The book provides up-to-date information and encourages interdisciplinary cooperation.

Posttraumatic stump formation and replantation of the severed limb are both reconstructive plastic operations which may lead to the improvement or destruction of a patient's lifestyle. For the primary attending surgeon, the decision whether to undertake such an operation depends on the patient's clinical condition, the operational circumstances, the psychological and social aspects and, last but not least, on the surgeon's own abilities. This monograph is designed as a synopsis of the great number of patho-physiological parameters and surgical and rehabilitational aspects which must be considered in the analysis of complications in major limb replantation. In addition, basic information about the key role of ischemic myopathy and microangiopathy is supplied to encourage further experimental investigations.

Fang Zhi-yang 1. 1 History of Traditional Treatment of Burns in China China is a country of ancient culture. The treatment of burn injury was documented more than 1500 years ago. As early as the Eastern Jin Dynasty, the Handbook of Prescriptions for Emergencies written by Ge Hong (281-341 A. D. ) and in the Southern Qi Dynasty (479-502 A. D. ) Liu J uan-Zi's Remedies Left Over by Ghosts, a book dealing mainly with diagnosis and treatment of traumatic wounds, are the earliest known monographs on "external diseases" in China. They record the treatment of burns with topical agents such as the preparation of a lard ointment of the liquid extract of Angelica anomalea Lallem, Gardenia jasminoides Ellis, Glycyrrhiza uralensis Fisch, Radia salviae miltiorrhizae, and the white cortex of willow. These herbs are found to be astringents and antibiotics. During the Sui Dynasty, a doctor of the Imperial Medical Academy (550- 630 A. D. ), Chao Yuan-fang, was authorized by imperial decree to compile the book General Treatise on the Etiology and Symptomatology of Diseases (610 A. D. ), the first book on etiology and symptomatology in China. This book with its valuable descriptions has been an authoritative and important reference for medical students for more than 1000 years.

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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

An excellent reference for the experienced breast surgeon is now available in Plastic and Reconstructive Breast Surgery, An Atlas. It assumes that the reader has a solid foundation in plastic surgery and is familiar with various operative methods. It describes the complete range of breast surgery: augmentation and reduction mammaplasty, anomalies, the treatment of primary breast cancer and breast reconstruction. The various flaps and grafts are described with emphasis placed on the presentation of specific details and complications. This is done with a series of illustrations and an accompanying text that is very easy to read. By looking up a similar case, the surgeon will find direct help for his own decision-making. Many less common types of cases are included to provide the broadest coverage possible. Coming from a single hospital, this atlas gives up-to-date information based on years of expertise. The authors present only the methods and techniques that have proved most successful at their hospital in the past two decades. A comprehensive bibliography directs you to further reading.

Die Infektion ist nach wie vor ein gravierendes Problem bei der Behandlung brandverletzter Patienten. Erkenntnisse uber die Pathophysiologie des Verbrennungstraumas und der Sepsis zeigen neue Therapieansatze auf und stellen konventionelle Behandlungsschemata teilweise in Frage. Die neuen Erkenntnisse uber Pathologie und Pathophysiologie septischer Komplikationen, die Aetiologie der Infektion, Infektionswege und Infektionskontrolle stellt dieses Buch dar. Es bietet allen, die Verbrennungen medizinisch behandeln, Hilfestellung bei der taglichen Arbeit.

Over the past ten years, carbon dioxide laser surgery has made impressive strides and is now applied to every field of surgery without exception. It is the intention of this book to record the work done in this field in the Department of Plastic and Maxillofacial Surgery of the Beilinson Medical Center and Tel Aviv University Medical School, Israel, as well as that performed in association with other depart ments. In this context, one feels that it is incumbent upon one to acknowledge the cooperation of the medical and paramedical staff of the Department of Plastic and Maxillofacial Surgery of the Beilinson Medical Center, as well as that of Prof. Yehuda Shindel and Dr. Daniel Katenelson of the Department of Ear, Nose and Throat, Dr. Y ona Tadir of the Department of Obstetrics and Gynecology and Dr. Itamar Kott of the Department of General Surgery. I should like to make special mention of Dr. Ralph Ger of New York, who worked with me on the original clinical trials, and the engineer Uzi Sharon, who developed the Sharplan Laser with me. The progress of Laser Surgery is well demonstrated by the participation in the four meetings of the International Society for Laser Surgery, the first of which was held in Tel Aviv in 1975 with an attendance of 65 and the last in Tokyo in 1981 with an attendance of 1200.

A different kind of book! The clivus of skull base is an area difficult to reach in neurosurgery, otorhinolaryngolo- gy, maxillo-facial surgery, plastic surgery, reconstructive surgery, and orthopedic surgery. It is for this reason that the various specialities gave found different approaches for different operations.

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."

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.

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."

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.

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."

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.

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."

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.

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".