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".

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.

Each year in the United States, an estimated 40,000 persons lose a limb. Of these amputees, approximately 30% lose a hand or an arm. This loss is most frequently related to trauma occurring in the healthy young adult male and is often work related. Approximately 3% of all amputees are born with congenital limb absence. In children, the ratio of congenital to acquired amputation is 2: 1, and the ratio of upper-limb to lower-limb amputees is 1. 2: 1. Therefore, since relatively few amputations result in upper-limb loss, only a small number of health practitioners, even those specializing in amputee rehabilitation, have the opportunity to provide services for a significant number of arm amputees. As a result, clinicians need to share their experiences so that the full range of options for optimum care and rehabilitation of the patient population may be considered. To meet this challenge for wider communication of clinical experience, a group of upper-limb amputee specialists met in Houston, Texas, in 1981 to serve as the core faculty for a course entitled "Contemporary Issues in Upper Extremity Amputation and Prosthetic Function. " This program provided the opportunity for surgeons, physiatrists, engineers, prosthetists, social workers, psychologists, occupational therapists, and physical therapists from the United States and Canada to discuss their extensive experience in working with upper extremity amputees. A second conference continuing the discussion of upper limb amputee rehabilitation was held one year later."

The skin allograft has been used as the test tool since the beginning of investiga tions of the fate of skin transplanted between two individuals of ordinary genetic diversity. This monograph is designed to furnish the transplantation work er with a review of the significant papers in which skin allografts and xeno grafts, applied to experimental animals and man, have played a role in acquiring a body of knowledge concerning the behavior and fate of these transplants and the reaction of the body to their presence. Skin, an essential organ for survival, a barrier between the "milieu inte rieur" of Claude Bernard and the "milieu exterieur," will remain the most frequently used transplant in transplantation research. Because it is highly antigenic, the final solution of the problem of acceptance of allografts of various tissues and organs will probably depend upon the achievement of a permanent survival of skin allografts. My personal interest in transplantation, which originated during my surgi cal training, was rekindled when I met Peter Medawar (today Sir Peter) in England during World War II. I had joined, in 1940, an American Volunteer Surgical Unit (The American Hospital in Britain), organized and headed by Dr."

Practical Procedures in Aesthetic Plastic Surgery, written by one of the foremost authorities in the field, is the definitive "hands-on" guide for the practicing plastic surgeon. Each chapter presents the actual execution of a specific surgical technique and illustrates the finer points that separate unacceptable from state-of-the-art surgical results. Aesthetic plastic surgery procedures from head-to-toe are covered, including blepharoplasty, rhytidectomy, abdominoplasty, suction-assisted lipectomy, breast augmentation, and lip enhancement. Over 500 photographs and line drawings, with 46 in full color, are the thrust of the book's benefit to the practicing surgeon, as each clearly defines the technical maneuvers essential in achieving flawless results. Prevention of mistakes as well as correction and repair of poor technique are also emphasized - an area that few books stress at all. Truly the most clear-cut technical volume available, this book should be in the hands of all practicing plastic surgeons and residents.

Here, one of the most respected otoplasty surgeons has written the definitive book on the latest techniques. Jack Davis brings the plastic surgeon and the otolaryngologist up to date with the newest concepts and methods for reconstructive and aesthetic plastic surgery of the ear. The volume contains such hot topics as secondary otoplasty, "eplasty", "sandwich" methods, radical auriculoplasty and stereotaxic surgery, but also covers histogenesis and growth of cartilage, auricular functional properties and embryology of the external ear. With the authors own beautiful drawings and preceded by a foreword by Dr. Blair Rogers, Otoplasty: Aesthetic and Reconstructive Techniques will undoubtedly fill an important niche in the market.

This volume is published with a triple aim: to take a look back over the advances during the ten years of the Mediterranean Burns Club and mark its anniversary; to follow up and strengthen the successful twin ning of burns as a clinical, individual illness problem and fires as a societal, disaster management problem; and to look ahead at the per spectives of burn care and fire prevention in the fast-approaching new century. The occasion also marks the tenth annual presentation of the prestigious G. Whitaker International Burns Prize, to which the Mediterranean Burns Club acts as the scientific fulcrum. The award is now established as the most distinguished recognition in burns science worldwide, and it is gratifying that the contributions of many of the renowned recipients will be found in this book. This is a sequel to The Management of Mass Burn Casualties and Fire Disasters, which contained the Proceedings of the First International Conference on Burns and Fire Disasters. The book and the conference have fully justified the authors' initial concept that burn specialists, con stantly combatting burn disease and promoting rehabilitation of the victims, especially in mass casualty situations, had for too long remained separate from that other essential sector, the fire-fighting authorities and fire prevention systems, whose aim is also the protection of the individual and the promotion of safety. This long overdue synergism has now become reality, and the present volume strengthens this desirable trend."

Fundamentals of Revision Hip Arthroplasty: Diagnosis, Evaluation, and Treatment is a unique and very timely book designed for surgeons who are beginning to more commonly encounter hip revisions in their practice. Unlike many traditional books on revision, Fundamentals of Revision Hip Arthroplasty does not focus on the most difficult and challenging of cases. Rather, Fundamentals of Revision Hip Arthroplasty is intended to guide the surgeon in the evaluation of the failed or painful total joint replacement, review basic tenants and surgical principles of revision arthroplasty, and guide the surgeon in determining whether a given case is one that should be managed or is best referred to a tertiary orthopedic center. Along with their 32 contributors, Dr. David J. Jacofsky and Dr. Anthony K. Hedley provide detailed information inside Fundamentals of Revision Hip Arthroplasty, including appropriate preoperative evaluation, equipment requirements, surgical planning, need for augments and allograft, and surgical techniques. Surgeons will be tackling hip revision surgery more frequently as the number of these cases is exponentially increasing. Fundamentals of Revision Hip Arthroplasty provides a "go-to" resource to turn to for guidance by community arthroplasty surgeons, arthroplasty fellows, and residents.

This comprehensive volume examines the possible complications that can arise in cutaneous surgery. The demand for outpatient cutaneous surgery procedures has increased at a rapid rate over the last several decades. As the number of cutaneous surgery procedures rises, so will the rate of complications, which are inevitable and occur even with the most skilled, careful, and meticulous surgeons. This work will help the practicing physician to formulate a preoperative strategy that will prevent complications before they occur as well as properly diagnose and manage complications if they arise, allowing the physician to provide optimal care to the patient.

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.

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.

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."

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.