Injury, 11,171-172 Printed in Great Britain 171

Abstracts

Organization topics and accident prevention Motorcycle and bicycle accidents Motor and pedal cyclists have a higher casualty rate per mile travelled than all other users of our roads. Motorcyclists' death rates have been estimated as being twice those of pedal cyclists and 24 times those of motorists, and passengers on motorcycles fare worse than their drivers. Although the rate of accidents among motorcyclists has not altered much since 1974, the number of casualties has risen alarmingly with the number of machines in use.

Seventy per cent of motorcyclists are injured by collisions, usually with motorcars and often at junctions. About one injured motorcyclist in three is the innocent victim of another person's error or omission. Improving the visibility of motorcyclists offers some protection for them, but being always on the lookout for them is better. Youth and inexperience are specially dangerous and it is astonishing that a motorcyclist can lawfully ride his machine for ever without having taken a test. In a survey, the Transport and Road Research Laboratory found that 73 per cent of drivers had only a provisional licence. Although instruction is available, only 10 per cent of motor- cyclists make use of it, which makes it all the more important to know that a training programme initiated by a committee of the Royal Australasian College of Surgeons (British Colleges, please note) was followed by a 51 per cent drop in motorcycle accidents.

The motorcyclist's exposed position is his biggest disadvantage and notwithstanding the fact that helmets are the most effective form of protection against serious injury and death there are those who resent being compelled by law to wear them.

With pedal cyclists, the number, but not the rate, of accidents has increased in recent years and one result of the increasing use of these machines is the exposure of older cyclists to conditions of traffic of which they have little cycling experience and in which motorists are no longer as used to pedal cyclists as they were, Nevertheless, it is still children who are most at risk, Training helps when they are riding with a purpose but not when they are playing in the street, which is when most accidents happen to them.

The continuing mixture of persons on two wheels with those on four is bound to be dangerous; it can be reduced, but it cannot be eliminated. Protective gear and the awareness of danger that comes from training can also do something to reduce accidents.

A Special Correspondent (1979) Motorcycle and bicycle accidents. Br. Med. J. 1, 39.

Tranquillizers and accidents In a prospective study of 43 117 persons, 57 persons who were killed or injured while driving motorcars or riding motor or pedal cycles were compared with 1425 matched controls. The study showed a statistically highly significant association between the use of minor tranquillizers and the risk of a serious road accident: the difference was nearly 5 to I. It was not possible to state whether the drugs or the condition that they were used to treat were responsible for this difference.

Skegg D. C. G., Richards S. M. and Doll R. 0979) Minor tranquillizers and road accidents. Br. Med. J. 1, 917.

Thoracic and abdominal injuries Latissimus dorsi myocutaneous flap The authors have worked out very carefully the vascular anatomy of the various myocutaneous flaps that can be designed from the latissimus dorsi muscle and its overlying skin. They conclude and demon- strate that these flaps are remarkably durable and versatile. Skin segments can be as narrow as 3 cm or as wide as 30 cm, and flap necrosis did not occur in any of their patients so far treated. They also describe a posterior advancement of this flap as a very useful procedure in the repair of meningomyelocoele defects. This is a paper to be consulted in the original text.

McGraw J. B., Penix J. O. and Baker J. W. 0978) Repair of major defects of the chest wall and spine with the latissimus dorsi myocutaneous flap. Plast. Reconstr. Surg. 62, 197.

Free lateral thoracic flap In this paper the authors describe in detail the vascular anatomy of the free lateral thoracic flap which can be based on the thoracodorsal vessels, the lateral thoracic vessels of the accessory lateral thoracic vessels. Since June 1976, eleven such flaps have been raised and transferred to different parts of the head and neck, using microvascular anastomotic techniques. This is a beautifully presented paper which must be consulted in the original text.

Harii K., Torii S. and Sekiguchi J. (1978) The free lateral thoracic flap. Plast. Reconstr. Surg. 62, 212.

Injuries of the head and spine Bitemporal flap repair The writer presents several cases in which a bitemporal flap repair has given very impressive results in the treatment of relatively small but never- theless difficult forehead wounds complicated by skin