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Photodamage
British Journal ofJ%stic Surgery (1997), 50, 146-147 Q 1997 The British Association of Plastic Surgeons
Book reviews Jackson. Although much of the material has been presented elsewhere, this remains an excellent exposition of the methods of approach for resecting tumours which were previously classified as unresectable. This leads nicely on to the chapter on neurofibromatosis and on vascular abnormalities of the orbit. Once again, the strength of the book is illustrated by the obvious experience of the authors in these areas. Chapter 12 is one which bears multiple reading. It deals with orbital tumours and their treatment. Being divided into two main sections, a section on minor reconstruction and one on major reconstruction, an unfortunate exclusion from the latter is the use of free tissue transfer. One is surprised at the lack of a radial forearm, rectus, or latissimus dorsi flap. Chapter 13 on palpebral degeneration sits a little uneasily between two major topics and may well have been better put nearer to chapters 7 and 8 which deal essentially with soft tissue surgery of the eyelids. However, in spite of its mal-location, it deals well with entropion and ectropion in a clear and succinct manner. Next is a SO-page chapter on “orbit0-palpebral trauma” which is at its strongest in dealing with bony trauma (Joe Gruss). It also has a superb exposition of the use of small flaps around the eyelids (J. van der Meulen). Unfortunately, the section on palpebral reconstruction of major defects is disappointing. Every plastic surgeon should be required to read chapter 15 which is on reconstruction of the socket. The postnucleation syndrome is explained and solutions are clearly outlined. Local, galeal and free flaps are all illustrated and the results speak for themselves. It is a great shame that the following and final chapter on lacrimal apparatus surgery is disappointing, thereby giving the impression of its being an afterthought. Such an excellent book should finish on an upswing and this chapter would have been better placed following chapter 10 which deals with orbital trauma. In conclusion, this is a beautifully presented textbook which would grace the coffee table and scientific bookshelf alike. It represents excellent value for both the hospital or university library and also for the library of the interested specialist and generalist. M. J. EARLEY
Colour Atlas and Text of Ocular Plastic Surgery. By J. C. van der Meulen and J. S. Gruss. Mosby-Wolfe Inc., London 1996. ISBN O-7234-1924-8. Pp. xviii+311, ill. Price &120.00. Reviewing a book which is so lavishly illustrated as this may seem at first to be an easy task. However, it is filled with such detail and so much of interest that it requires reading several times. It is aimed at both the generalist and the specialist but primarily the latter. It is not a textbook for examination study but is more a manual from which one can benefit from the extensive experience of the authors. It is superbly presented and all of the illustrations are of a high standard which is unusual for many modern clinical books. Unfortunately, on occasions the diagrams hint at far more than is explained in the text which can be irritating at times. This is very apparent in chapter one on anatomy where, for example, the topographical anatomy of Lockwood’s ligament remains a mystery to the reader. There are good references at the end of each chapter and surprisingly, for a multi-author book, there has obviously been a strong editorial hand which has helped an even style throughout. The topics are presented in 16 chapters, the first being a beautifully illustrated but disappointing chapter on orbital anatomy. There are certainly better texts in existence with respect to this topic. The second chapter deals with three-dimensional CT imaging and unfortunately begins with a section which fails to relate basic information to explanatory illustrations. However, the latter section of this chapter demonstrates the clinical application of three dimensional reconstruction in an excellent manner providing impressive examples of the usefulness of this type of imaging. There are references made to orbital anatomical cryosections which to this reader seemed unnecessary and unhelpful in this context. After the above introductory chapters, there follows a general chapter on orbital surgery. Several interesting flaps are presented as are the principles of orbital osteotomy. The placing of bony cuts is well explained and graphically shown. A minor quibble is that there should be a better exposition of temporalis and temporoparietal flaps. Canthal fixation is elegantly dealt with and shown in a concise and clear manner. The following chapter on orbital and eyelid expansion is a gem of a chapter answering most questions that would be asked by a specialist while at the same time providing the generalist with detailed education. Chapters five and six cover telorbitism, malorbitism and encephalocoeles. These are a little brief, considering that much of this work is at the core of an oculoplastic surgeon’s practice and many readers would wish to benefit from the extensive experience of the combined authors. Chapter seven deals with neuromuscular anomalies and is written by Serge Morax who is an ophthalmologist in Paris. In this, he covers ptosis, eyelid retraction and facial palsy problems, intermarrying a clear text with even clearer clinical photographs which take the reader step by step through various operations. There follows a section on palpebral abnormalities which covers telecanthus, blepharophimosis, coloboma, epiblepharon, ectropion and entropion. This chapter is a superb example of the advantage brought to the book by the wide experience of Jacques van der Meulen. The following chapter on orbital decompression unfortunately sits uneasily at the mid-point of the book. It outlines the two main methods of decompression-that of bony resection and that of removal of fat-but does not resolve the question of which method to use and adds little to the sum total of knowledge in this area. Chapter 10 deals with orbital tumours and is written by Ian
Photodamage. Edited by Barbara A. Gilchrest. Blackwell Science, USA 1995. ISBN O-86542-343-1. Pp. xiii+295, ill. Price E69.50. The study of cutaneous photobiology is declared to be a ‘thriving, zesty and exciting enterprise delivering new discoveries monthly’. Dr Gilchrest has edited a text written by experts in the field of photodamage. It is a well-written scientific collection of data and results. The main subjects discussed are the magnitude of the problem of photodamage, sunburn and suntan, the mechanisms of skin repair as well as protection of sun damage with sunscreens. Concluding chapters deal with the treatment of sun-damaged skin with retinoids, tretinoin and antioxidants. For plastic surgeons who would like to understand at a molecular level how sun damage can trigger malignancy and prematurely age the skin great detail is available. Evidence that the skin has a memory for sun damage is summarised and is interesting to read, particularly so because plastic surgeons deal with a lot of naevi which tend to be more common in sun-exposed (or damaged) parts. Prophylactic treatments in at-risk patients for cancer have been evaluated with the condition Xeroderma Pigmentosum as a model. It is probably important to read about the effects of retinoids in a book such as this since they are used as cosmetic wrinkle removers by some. I learned that retinoids may promote a biological repair process by dermal collagen deposition and that natural
146
Book Reviews and synthetic antioxidants (such as vitamin E) may mitigate against sun damage to skin. This is probably a book more of interest to an individual dermatologist rather than plastic surgeon, although it would be useful to dip into from a library for some basic science on sun damage and repair. I have no complaints about the layout, illustrations, reference or index - my only disappointment was an incongruous chapter on facelifting, blepharoplasty, chin augmentation and collagen injections which was bolted onto the end under the guise of ‘adjunctive procedures in the treatment of photodamaged skin’. P. N. HALL
Surgical Adhesives and Sealants: Current Technology and Applications. Edited by D. H. Sierra and R. Saltz. Technomic Publishing Co. Ltd, Pennsylvania, 1996. Pp. xx+247, ill. ISBN l-55676-327-4. Price $69.00. The field of tissue adhesives, which encompasses traditional glues, gel matrices and, more recently, sealants manipulated out of natural body components such as blood, collagen, cultured cells and derived fibrins, is currently undergoing considerable intense research in particular within the area of applications for such materials. It is, therefore, very topical that an up-to-date publication of this nature should be available at this time. The symposium from which the articles have been transcribed was an international meeting of many workers from all areas of sealant researchclinical, experimental, commercial, military, surgical and pathological. This broad base of expertise is very well represented within this book and the organisation of the component sections creates an easily negotiated matrix of data. There are many examples of the increasing use of some of the currently available fibrin sealants in considerably diverse clinical applications including cosmetic facial surgery, plastic and reconstructive surgery, skin grafting, endoscopic surgery, treatment of burns, otolaryngology, nerve repair and otology/neurotology. Equally exciting are the chapters reporting experimental work describing the use of sealants to deliver active pharmaceutical compounds, such as growth factors, antibiotics, specific tissue repair factors and other molecules, to the site of injury or the site at which the active intervention is required. A similar but separate
147 area which is well described is the delivery of skin cells within fibrin sealants and the suggestion that cells may even be grown directly into the sealant to be applied to an injury, thus presenting an opportunity to graft cells onto wounds within the vehicle used to seal the wounds. This work apparently stems from research, reported in this publication, showing that fibrin sealant can be used as a glue to attach skin to graft sites, completely avoiding the use of sutures. The kinetics of the fibrin sealant when used either as a tissue glue or as a haemostatic sealant are probably the most important physical parameter influencing effective bond strengths. The chapters covering this aspect are fewer than might be expected but they do cover all current concerns regarding glue strength and sealing properties and the kinetics involved which might be manipulated to increase effectiveness. It would seem, from the manuscripts published in this book, that the current trend of thought is toward totally autologous fibrin sealants, although this possibility does seem a little way in the future owing to the problems of additives and systems which would be necessary for such a sealant. The reasons for looking towards totally autologous materials are found in many of the experimental and clinical chapters but are also covered from the legal point of view by a section which assesses the attitude of the FDA and other licensing bodies to sealants containing any foreign proteins and those made from pooled human blood sources. Surgical sealants and adhesives, current technology und applications will be a useful data book not only for those laboratories researching experimentally within the area of tissue repair but also to the surgeons and clinicians who will no doubt soon be looking towards applying sealants in an expanding number of surgical procedures and pharmaceutical interventions. P. D. SIBBONS
Notes on our Reviewer M. J. Earley FRCS, Consultant Plastic Surgeon, Mater Misercordiae Hospital, Dublin, Ireland. P. N. Hall FRCS(Plast), Consultant Plastic Surgeon, Department of Plastic and Reconstructive Surgery, Addenbrooke’s Hospital, Cambridge. Paul D. Sibbons FIMBS, PhD, Senior Lecturer, Department of Surgical Research, Northwick Park Institute for Medical Research, Harrow, Middlesex.
Book reviews Jackson. Although much of the material has been presented elsewhere, this remains an excellent exposition of the methods of approach for resecting tumours which were previously classified as unresectable. This leads nicely on to the chapter on neurofibromatosis and on vascular abnormalities of the orbit. Once again, the strength of the book is illustrated by the obvious experience of the authors in these areas. Chapter 12 is one which bears multiple reading. It deals with orbital tumours and their treatment. Being divided into two main sections, a section on minor reconstruction and one on major reconstruction, an unfortunate exclusion from the latter is the use of free tissue transfer. One is surprised at the lack of a radial forearm, rectus, or latissimus dorsi flap. Chapter 13 on palpebral degeneration sits a little uneasily between two major topics and may well have been better put nearer to chapters 7 and 8 which deal essentially with soft tissue surgery of the eyelids. However, in spite of its mal-location, it deals well with entropion and ectropion in a clear and succinct manner. Next is a SO-page chapter on “orbit0-palpebral trauma” which is at its strongest in dealing with bony trauma (Joe Gruss). It also has a superb exposition of the use of small flaps around the eyelids (J. van der Meulen). Unfortunately, the section on palpebral reconstruction of major defects is disappointing. Every plastic surgeon should be required to read chapter 15 which is on reconstruction of the socket. The postnucleation syndrome is explained and solutions are clearly outlined. Local, galeal and free flaps are all illustrated and the results speak for themselves. It is a great shame that the following and final chapter on lacrimal apparatus surgery is disappointing, thereby giving the impression of its being an afterthought. Such an excellent book should finish on an upswing and this chapter would have been better placed following chapter 10 which deals with orbital trauma. In conclusion, this is a beautifully presented textbook which would grace the coffee table and scientific bookshelf alike. It represents excellent value for both the hospital or university library and also for the library of the interested specialist and generalist. M. J. EARLEY
Colour Atlas and Text of Ocular Plastic Surgery. By J. C. van der Meulen and J. S. Gruss. Mosby-Wolfe Inc., London 1996. ISBN O-7234-1924-8. Pp. xviii+311, ill. Price &120.00. Reviewing a book which is so lavishly illustrated as this may seem at first to be an easy task. However, it is filled with such detail and so much of interest that it requires reading several times. It is aimed at both the generalist and the specialist but primarily the latter. It is not a textbook for examination study but is more a manual from which one can benefit from the extensive experience of the authors. It is superbly presented and all of the illustrations are of a high standard which is unusual for many modern clinical books. Unfortunately, on occasions the diagrams hint at far more than is explained in the text which can be irritating at times. This is very apparent in chapter one on anatomy where, for example, the topographical anatomy of Lockwood’s ligament remains a mystery to the reader. There are good references at the end of each chapter and surprisingly, for a multi-author book, there has obviously been a strong editorial hand which has helped an even style throughout. The topics are presented in 16 chapters, the first being a beautifully illustrated but disappointing chapter on orbital anatomy. There are certainly better texts in existence with respect to this topic. The second chapter deals with three-dimensional CT imaging and unfortunately begins with a section which fails to relate basic information to explanatory illustrations. However, the latter section of this chapter demonstrates the clinical application of three dimensional reconstruction in an excellent manner providing impressive examples of the usefulness of this type of imaging. There are references made to orbital anatomical cryosections which to this reader seemed unnecessary and unhelpful in this context. After the above introductory chapters, there follows a general chapter on orbital surgery. Several interesting flaps are presented as are the principles of orbital osteotomy. The placing of bony cuts is well explained and graphically shown. A minor quibble is that there should be a better exposition of temporalis and temporoparietal flaps. Canthal fixation is elegantly dealt with and shown in a concise and clear manner. The following chapter on orbital and eyelid expansion is a gem of a chapter answering most questions that would be asked by a specialist while at the same time providing the generalist with detailed education. Chapters five and six cover telorbitism, malorbitism and encephalocoeles. These are a little brief, considering that much of this work is at the core of an oculoplastic surgeon’s practice and many readers would wish to benefit from the extensive experience of the combined authors. Chapter seven deals with neuromuscular anomalies and is written by Serge Morax who is an ophthalmologist in Paris. In this, he covers ptosis, eyelid retraction and facial palsy problems, intermarrying a clear text with even clearer clinical photographs which take the reader step by step through various operations. There follows a section on palpebral abnormalities which covers telecanthus, blepharophimosis, coloboma, epiblepharon, ectropion and entropion. This chapter is a superb example of the advantage brought to the book by the wide experience of Jacques van der Meulen. The following chapter on orbital decompression unfortunately sits uneasily at the mid-point of the book. It outlines the two main methods of decompression-that of bony resection and that of removal of fat-but does not resolve the question of which method to use and adds little to the sum total of knowledge in this area. Chapter 10 deals with orbital tumours and is written by Ian
Photodamage. Edited by Barbara A. Gilchrest. Blackwell Science, USA 1995. ISBN O-86542-343-1. Pp. xiii+295, ill. Price E69.50. The study of cutaneous photobiology is declared to be a ‘thriving, zesty and exciting enterprise delivering new discoveries monthly’. Dr Gilchrest has edited a text written by experts in the field of photodamage. It is a well-written scientific collection of data and results. The main subjects discussed are the magnitude of the problem of photodamage, sunburn and suntan, the mechanisms of skin repair as well as protection of sun damage with sunscreens. Concluding chapters deal with the treatment of sun-damaged skin with retinoids, tretinoin and antioxidants. For plastic surgeons who would like to understand at a molecular level how sun damage can trigger malignancy and prematurely age the skin great detail is available. Evidence that the skin has a memory for sun damage is summarised and is interesting to read, particularly so because plastic surgeons deal with a lot of naevi which tend to be more common in sun-exposed (or damaged) parts. Prophylactic treatments in at-risk patients for cancer have been evaluated with the condition Xeroderma Pigmentosum as a model. It is probably important to read about the effects of retinoids in a book such as this since they are used as cosmetic wrinkle removers by some. I learned that retinoids may promote a biological repair process by dermal collagen deposition and that natural
146
Book Reviews and synthetic antioxidants (such as vitamin E) may mitigate against sun damage to skin. This is probably a book more of interest to an individual dermatologist rather than plastic surgeon, although it would be useful to dip into from a library for some basic science on sun damage and repair. I have no complaints about the layout, illustrations, reference or index - my only disappointment was an incongruous chapter on facelifting, blepharoplasty, chin augmentation and collagen injections which was bolted onto the end under the guise of ‘adjunctive procedures in the treatment of photodamaged skin’. P. N. HALL
Surgical Adhesives and Sealants: Current Technology and Applications. Edited by D. H. Sierra and R. Saltz. Technomic Publishing Co. Ltd, Pennsylvania, 1996. Pp. xx+247, ill. ISBN l-55676-327-4. Price $69.00. The field of tissue adhesives, which encompasses traditional glues, gel matrices and, more recently, sealants manipulated out of natural body components such as blood, collagen, cultured cells and derived fibrins, is currently undergoing considerable intense research in particular within the area of applications for such materials. It is, therefore, very topical that an up-to-date publication of this nature should be available at this time. The symposium from which the articles have been transcribed was an international meeting of many workers from all areas of sealant researchclinical, experimental, commercial, military, surgical and pathological. This broad base of expertise is very well represented within this book and the organisation of the component sections creates an easily negotiated matrix of data. There are many examples of the increasing use of some of the currently available fibrin sealants in considerably diverse clinical applications including cosmetic facial surgery, plastic and reconstructive surgery, skin grafting, endoscopic surgery, treatment of burns, otolaryngology, nerve repair and otology/neurotology. Equally exciting are the chapters reporting experimental work describing the use of sealants to deliver active pharmaceutical compounds, such as growth factors, antibiotics, specific tissue repair factors and other molecules, to the site of injury or the site at which the active intervention is required. A similar but separate
147 area which is well described is the delivery of skin cells within fibrin sealants and the suggestion that cells may even be grown directly into the sealant to be applied to an injury, thus presenting an opportunity to graft cells onto wounds within the vehicle used to seal the wounds. This work apparently stems from research, reported in this publication, showing that fibrin sealant can be used as a glue to attach skin to graft sites, completely avoiding the use of sutures. The kinetics of the fibrin sealant when used either as a tissue glue or as a haemostatic sealant are probably the most important physical parameter influencing effective bond strengths. The chapters covering this aspect are fewer than might be expected but they do cover all current concerns regarding glue strength and sealing properties and the kinetics involved which might be manipulated to increase effectiveness. It would seem, from the manuscripts published in this book, that the current trend of thought is toward totally autologous fibrin sealants, although this possibility does seem a little way in the future owing to the problems of additives and systems which would be necessary for such a sealant. The reasons for looking towards totally autologous materials are found in many of the experimental and clinical chapters but are also covered from the legal point of view by a section which assesses the attitude of the FDA and other licensing bodies to sealants containing any foreign proteins and those made from pooled human blood sources. Surgical sealants and adhesives, current technology und applications will be a useful data book not only for those laboratories researching experimentally within the area of tissue repair but also to the surgeons and clinicians who will no doubt soon be looking towards applying sealants in an expanding number of surgical procedures and pharmaceutical interventions. P. D. SIBBONS
Notes on our Reviewer M. J. Earley FRCS, Consultant Plastic Surgeon, Mater Misercordiae Hospital, Dublin, Ireland. P. N. Hall FRCS(Plast), Consultant Plastic Surgeon, Department of Plastic and Reconstructive Surgery, Addenbrooke’s Hospital, Cambridge. Paul D. Sibbons FIMBS, PhD, Senior Lecturer, Department of Surgical Research, Northwick Park Institute for Medical Research, Harrow, Middlesex.