BOOK REVIEWS 263

support whilst extra oral strapping is being applied, if the risk of

overlap of the segments in the alveolar cleft area as illustrated in

Fig. 5.16 (b), is to be minimised).

This book will be of immediate interest to orthodontists and

their technicians, and to the postgraduate dental student studying for a higher qualification. It will also provide an

explanatory background to plastic surgeons who work in close

co-operation with their orthodontic colleagues.

At f25 the book could be regarded as expensive, but the

number of illustrations and high quality paper on which the

book ib printed results in good value for money. In the

concluding chapter, the author begs his reader to judge whether

the goal3 proclaimed at the beginning of the book have been

attained. In the reviewer’s opinion they have-with merit.

PETER BUSH

Clinical Applications for Muscle and Musculocutaneous Flaps. By J. Mathes and Foad Nahai, with 13 contribu-

tors. Pp xvi + 733 with 1053 illustrations including 41 in colour. (St Louis, Toronto, London: The C. V. Mosby Company, 1982). Price f102.00.

This magnificent volume is a sequel to the “Clinical Atlas of

Muscle and Musculocutaneous Flaps” published in 1979 by the

came authors. But while the atlas is based almost entirely on

diagrams and cadaver dissections, this text, as befits its title, is copiously illustrated with clinical cases, in addition to the

previous material. The scope of reconstructive surgery has

extended so much in recent years that it is no longer possible for

one to be conversant with all the details of every conceivable

flap, so this volume fulfils a real need as a reference volume. So

too arises the need for 13 contributing authors to cover a wide

variety of topics with special expertise. It contains much

material that one recognises both from the previous volume and

from the published works of the various authors.

The text is laid out in five parts. The first, entitled Principles,

is required reading for the neophyte in musculocutaneous flap

surgery. The chapter on flap selection is little more than an introduction but does bring up the question of function

preservation. There is a large table of specifications for muscle

and musculocutaneous flaps in which I was unable to ascertain

the significance of the shaded areas, but the “Best Buys”

appear in heavy type. The chapter on Vascular Anatomy

includes the authors’ published work on classification and is the

essential basic science on which much of clinical practice,

especially of more refined techniques, is based. There follows a

detailed summary of the vascular anatomy and clinical appli-

cation of all the commonly used muscles. The information in the muscle-by-muscle examination of musculocutaneous per-

forators could perhaps have been incorporated in this chapter,

while the diagram of the blood supply of skin will have to be

modified in the light of recent knowledge about direct cutaneou\ vessels following the intermuscular septa in the limb\.

The short chapter on Experimental Considerations, while

interesting, is out of place in a textbook of clinical applications.

The following chapter on Flap Failure may seem to be stating

the obvious but at times the obvious needs to be stated! This

chapter contains a number of aphorisms which. if followed,

should minimise flap failure.

As befits the title of the book more than 477 pages are devoted to the applications, the body being divided into ten

areas: head and neck; anterior thorax; posterior trunk;

abdomen; groin and perineum; lower extremity and upper

extremity. The breast, pressure sores and the foot are con-

sidered separately. In each area the same analytical format is

adopted: a systematic approach to flap selection; reconstruc-

tion and complications. The systematic approach to flap

selection shows diagrammatically the flaps applicable to each

area and presents some illustrative examples with the minimum

of text. Then follows a major chapter on reconstruction. In

several areas the work is readily recognised having been

published previously in Plastic and Reconstructive Surgerv and

due acknowledgement is given. The chapters on complications

are stated as presenting specific complications inherent to each

flap but in fact there is a certain amount of duplication, as at least some of the problems discussed can arise equally with any

flap.

Practically every conceivable defect is considered. Space does

not permit discussion of all of them, but fortunately in this

country we are spared some of the worst. Perhaps our

Radiotherapists are a little gentler? The prevalence of a simple

rather than a modified radical mastectomy also makes the

reconstructive surgeon’s task easier. In some areas the superi-

ority of a local axial flap is mentioned and the place of the scalp flap, deltopectoral flap and transverse lumbar flap is acknow- ledged. Not all of the examples shown fulfil the aim of

providing the “harpsichord” rather than the “log”, but this in

no way detracts from their value and will in fact assist the

discerning reader in his choice of flap. The third section on Transplantation considers the rnicro-

vascular free transfer of musculocutaneous flaps. The type of

muscle to use, indications, areas where free transfer is applic-

able and the specific muscles to use are all discussed followed by

a brief chapter on complications. The final section on Evalu-

ation includes a brief chapter on the use of fluorescein to assess

flap viability, which could perhaps have been more usefully

placed in Part I, preceding the chapter on “An analysis of

causes of flap failure”. The chapter on Long Term Evaluation

considers the question of how well a flap achieves its objectives

and how acceptable is the secondary defect-highlighting, for

example, the unacceptable secondary defect of the tnedial gastrocnemius flap.

The main criticism to be levelled at this text concerns layout

and repetition. The surgeon faced with a defect for which he

wishes to select and plan a flap must turn fir51 to theappropriate chapter on flap selection: then to two chapters in section one to

study the vascular anatomy and mubculocutaneous perforators,

then back to the definitive chapter on reconstruction of the area

in question, followed by complications, and finally to “ELalu-

ation” to assess the long term suitability. However, in fairness,

there is a vast amount of information in this book and probably

any arrangement of the text could be criticised in some way! The volume is superbly presented, spaciously laid out and copiously illustrated with diagrams and photographs, many of which are

in colour. It is easy to read and while many of the procedure5 are

now routine in other cases one ia impressed by the ingenuity 01 the solutions. It should be required reading for all trainees in

reconstructive surgery. It is an excellent reference volume for the surgeon faced Mith a problem defect, and it \hould

undoubtedly be found in every plastic ,urgrry unit’s depart-

264 BRITISH JOURNAL OF PLASTIC SURGERY

mental library. If you are a surgeon who takes a pride in your ability to reconstruct any defect, from the sole of the foot to the top of the head, you will want to buy this book, despite its high price.

ALAN G. LEONARD

The Musculo-Skeletal System: Embryology, Biochem- istry and Physiology. By Richard L. Cruess. Pp 397 with illustrations. (Edinburgh, New York: Churchill Living- stone, 1982). Price f45.00.

The first impression is of a well-produced book with clear print on good paper in the convenient size of lO”x7”. The illustrations of photomicrographs are quite superb, clearly labelled and presented with comprehensive legends and appro- priate cross-reference in the text. Although American, the format is conventional and has not adopted the trans-Atlantic custom of arranging the text into two columns per page. Indeed, there are few Americanisms overall, merely the odd use of words such as “perturbations” and “osteopenic” and oc- casional spelling differences that are inoffensive. The title is a true reflection of the contents of the book, although it should be noted that as there are only 33 pages on muscle and the equivalent (or less) on nerves and tendons, the emphasis is quite definitely on the biochemistry and physiology of bone and cartilage.

As a book mainly concerned with the workings of the skeletal system at a cellular level one of your reviewers (G.C.) found it admirable and well suited to his work as an anatomist involved in pre-clinical teaching: but for whom is it intended? Your other reviewer (G.L.) found that with the emphasis of the book pitched at the cellular level, it was less admirable, despite his personal interest in microsurgery. Those sections which would be of more interest, namely on muscles, nerve and tendon are given too little space and although comprehensible are by no means comprehensive.

The aim of the work, as indicated in the preface, is to organise the vast body of knowledge concerning the musculo- skeletal system in such a way as to make it comprehensible to someone “in training for a clinical discipline or practising a speciality”. By this we take it to mean medical graduates pursuing further specialist training, for although it would be true to say that medical students are also “in training” for an eventual clinical discipline, we think the book is too detailed for them. Furthermore, it reads like many rather boring scientific papers and there are few oases of description to refresh the weary traveller. Interestingly, those that do occur, for instance the description of osteoclasts as “cytologic streetcleaners”, chondrocytes in the proliferative zone of the epiphyseal plate as “stacked in coin-like columns” and acting as “hydraulic jacks” with the resultant bony funnels growing like “a stack of empty ice cream cones”, all appear in the chapter on embryology and development of the skeletal system and this is the one chapter one would recommend students to read.

If the book is really aimed at practising clinicians it is a pity that there are not more clinical correlates and virtually no relevant syndromes are mentioned other than in the chapter on muscle. The very short chapter on tendons (10 pages) concen- trates only on flexor tendon healing in the hand. Thechapter on

nerves would have been of greater value had it been expanded. The other 9 chapters concerning the various structural elements of the skeletal system, their growth and hormonal control, are straightforward reviews of the relevant biochemistry and physi- ology. The clinical aspects are but lightly touched on and some, such as electrically-stimulated osteogenesis, deserve more space.

The chapter on the structure, organisation and healing of bone is good with 294 references listed and a useful section for clinicians on dysfunctional bone remodelling. The equivalent chapter on cartilage has an interesting section on the repair capacity of articular cartilage in a variety of experimental situations.

The references are comprehensive and up-to-date. Several aspects of skeletal research of limited interest, for example, bone morphogenetic protein (BMP), the osteocalcins, the inter-relationship between Vitamin K and bone, to mention but a few are not listed in the index but are alluded to in the text with further sources of information indicated. It can thus be seen that this is an advanced text, ideal for those who want an overview of skeletal research. One of us (G.C.) is very pleased to have this book and hopes that Churchill Livingstone will produce a series of similar books: such dissertations on the embryology, biochemistry and physiology of the vascular system and of the skin are far more likely to be welcomed by plastic surgeons.

G. C. CORMACK B. G. H. LAMBERTY

Clinical Applications of Biomaterials. By A. J. C. Lee, T. Albrektsson and P.-l. Branemark. Pp 356 with 138 illustrations. (Sussex: John Wiley and Sons Limited, 1982). Price f27.50.

This volume reports the material presented at the Second European Conference on Biomaterials held in Gothenberg, Sweden in 1981. The volume includes 335 pages and the 39 articles each about eight pages long on average, including the diagrams and references. This is not therefore a volume reporting sophisticated analyses or wide ranging control tests, rather the emphasis is on short presentations of preliminary data relating to clinical applications of biomaterials.

The first 13 chapters are under the general heading of orthopaedics and relate to metals, carbon fibre, and other carbon based materials, ceramics, acrylic resin, polymethyl- methacrylate and cyanoacrylates. Of the 13 papers in this section, 7 related to tests on animals and 6 were laboratory bench tests, some related to mechanical analysis also. Generally the authors were looking at problems of replacement of human anatomical structures, such as ligaments, tendons and joints and in almost every case the techniques still had to be subjected to the greater imponderable of trials in man.

The second section of the book comprises nine chapters relating to developments in dentistry and related fields; 3 of these were animal studies, one a laboratory analysis and 5 related to the performance of humans, particularly in respect of implants of titanium and gold in the dental region. Six of these papers came from institutions in Gothenberg and Linkoping. These related to the use of titanium as a percutaneous structure