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Procedures in plastic and reconstructive surgery: How they do it
British Journal of Plasric Surgery 0
(1992). 45. 256-259
1992 The British Association of Plasic Surgeons
Book Reviews Colour Atlas of Aesthetic Surgery of the Abdomen. By Jorge M. Psillakis, Erdulfo Appiani and Rafael de la Plaza. Pp 1X+86. 73 Illustrations and Figures. (New York: Thieme Medical Publishers, Inc., 1991). Price DM148. ISBN O86571-343-2.
and the quality overall is good, though there are a few poorly exposed photographs included. Many plastic surgeons are not active in skeletal recontouring in the face. but for those who are, even if only for ‘deformity’ rather than ‘aesthetic’ problems, this is a useful and pleasant read. M. D. POOLE
Compared with other aspects of aesthetic surgery, very few books have been published on abdominoplasty. This book, with a foreword by Robert M. Goldwyn, aims “to present practical ways of performing an abdominoplasty, emphasizing the refinements which will attain beauty.. “. There are three main chapters which describe pre-operative evaluation, operative technique and post-operative management as practised by the authors. The broad range of aesthetic abnormalities with which patients present are usefully classified into six Types ranging from excess subumbilical fat only (Type 1) to large amounts of excess skin and fat together with laxity of the abdominal wall (Type V). Type VI patients are those with excess supra-umbilical skin who are best treated with a reverse abdominoplasty. The authors then describe how best the various surgical techniques can be applied to treat these Types with the aim of creating an appearance which approximates to the shape and contour of the ideal abdomen, which they define in the Introduction. They place particular emphasis on the value of using liposuction and external oblique muscle flaps (Psillakis and Appiani) to achieve normal appearance. The book is attractively presented and liberally illustrated with photographs and drawings, most of which are in colour and of excellent quality, but the text suffers somewhat from the quality of its translation into English. As a How-We-Do-It cook book on abdominoplasty, it succeeds but, alongside so many current publications on aesthetic surgery, this book is strikingly short of scientific objectivity in describing the outcomes of the several operative procedures which are advocated. Whilst complications are described, their incidences are not and no mention is made of the levels of patient satisfaction. A ‘Bibliography’ lists most of the important publications on abdominoplasty (and two unpublished titles given al symposia) but they are not referred to in the text. .4s this book presents a logical approach to the design and performance of abdominoplasties, it will be useful reading for surgeons who can input their own objectivity from personal experience. D. L. HARRIS
Handhook of Medicolegal Practice. Edited by John P. W. Varian. (Oxford, London, Boston, Munich, New Delhi, Butterworth-Heinemann Ltd., 1991). ISBN 0-7506-1238-X. Price: g19.50. Pp. ix+ 194, illustrated. The first time a medical practitioner encounters the law, apart from any personal extracurricular indiscretions, is usually as a registrar having been delegated a relatively straightforward medicolegal report by the consultant: yet there is little teaching or induction in order to prepare such a document, which may be of considerable importance in determining the fate of a plaintiff patient. The law relating to the practice of medicine and surgery is not adequately taught in medical schools at undergraduate or post graduate level and, although negligence is only one of the many facets of medical law, there is a need for a book giving medicolegal guidelines. The editor of the Handbook of Medicolegal Practice is a hand surgeon working exclusively in private practice in Dublin and opens with two chapters on how to make a report and how to behave in court, but in a flippant style which distracts from several good themes. Most of the other chapters are written by doctors representing their interests such as general practice, general surgery, obstetrics and gynaecology, orthopaedics, plastic surgery, otolaryngology and ophthalmology, and simply provide an incomplete litany of potential errors, complications and pitfalls which cannot be news for the relevant specialists. Those authors who do raise pertinent legal issues repeat what has already been said in the two best chapters; the first giving the lawyer’s view with an easily understood explanation of the principles of duty and standards of care, breach of duty and proof of medical negligence. The second clearly identifies how complaints arise, how to avoid them and what to do when they happen. However, every surgeon should read the chapter on anaesthetics which serves to emphasise the necessity of separate consent forms, one to be completed by the surgeon and the other by the anaesthetist. There is no doubt that this book fulfils a need but it could be so much better. There is too much repetition and overlap. For example, hand surgery is discussed by the editor, the orthopaedic surgeon and the plastic surgeon whereas it should be covered only by the invited hand surgeon who, incidentally, writes the best of the specialist chapters. The book can be recommended to any doctor on the strength of the two best chapters but any subsequent version could benefit from tighter editing (in its present form it tries to hit too many targets at too many different ranges), from a brief introductory chapter indentifying the goals more precisely and by a glossary of relevant legal and medicolegal terms. As a final section one might consider the weaknesses and occasional unfairness to patients of the present inordinately prolonged and labyrinthine system of seeking justice. There is no mention of no-fault compensation. C. M. WARD
Aesthetic Contouring of the Craniofacial Skeleton. Ed. Douglas K. Ousterhout. (Boston, Toronto, London, Little, Brown and Company, 1991). ISBN O-316-67410-9. Pp XXX + 576, ill. Price g195. This is a good book, and it is nice to see that a large work like this on aesthetic craniofacial surgery has been edited by such a respected practitioner of reconstructive craniofacial surgery as Dr. Ousterbout. The coverage is wide and takes in assessment, psychological considerations, surgical techniques and problems and complications. With the exception of rhinoplasty, most craniofacial skeletal recontouring procedures are included. While purely aesthetic procedures are described, much of the content is on surgery for what most would consider to be deformity. Discussion of conditions like hypertelorism. orbital dystopia, and syndromal deformities of the craniofacial skeleton is not present, however. Many surgeons active in this work from around the world have contributed. The content is divided up into sections on evaluation and diagnosis, materials for augmentation, surgical methods and long-term results, as well as an introductory section which includes an interesting chapter on cultural aspects of beauty. There are lots of illustrations. almost all black and white with just a few colour prints,
Procedures in Plastic and Reconstructive Surgery: How they do it. Edited by Lars M. Vistnes. (Boston, Toronto, London, Little, Brown and Company, 1991). ISBN O-316-90437-6. Pp xvi + 752. illustrated. Price f170. This book succeeds in its aim of detailing various operations of aesthetic and reconstructive surgery as performed by acknowledged experts mostly from North America. More than a third of the 256
Book Reviews book covers aesthetic operations, a fifth concerns the reconstructive surgery of congenital problems (but does not mention genital problems) and the rest is about reconstructive surgery of acquired problems. Its strength is in the very high standard of the text, the helpful and detailed diagrams and the general layout of the contents which makes reading it a pleasure, even on subjects which have been repeatedly written about in the past. The index is good, references are helpful and up-to-date. The weakness of this book for the British reader is the omission of several important procedures such as the surgery of hypospadias, pharyngoplasty, pressure sore surgery and the surgery of congenital hand abnormalities, Dupuytren’s disease and rheumatoid arthritis of the hand. Unfortunately the cost $170) is such that it will be beyond the means of most trainee plastic surgeons. Established plastic surgeons (for whom I am sure this book has been written) working in any of the many fields of plastic and reconstructive surgery will benefit from the up-to-date information so well presented and it will be a very useful addition to a Plastic Surgery Unit Library. D. S. MURRAY
Cosmetic Surgery of the Skin: Principles and Techniques. Edited by William P. Coleman III, C. William Hanke, Thomas H. Alt and Saul Asken. (USA, B. C. Decker Inc.; UK, Wolfe Publishing Ltd., 1991). ISBN 1-55664-176-l. Pp xii + 388, illustrated. Price E86.00. The purpose of this elegantly presented new multi-author book is to teach dermatologists the techniques of cosmetic surgery in which the specialty “ . . is beginning to define its role.. . “. The selection of material and manner of presentation make it something of a manifesto in its desire to restore to primacy the historical place of dermatologists in the development of cosmetic surgical techniques. Indeed, it is studious in its attempts to negate the contribution, and even existence, of plastic surgery in the historical preamble to each subject, in its approach to surgical technique, and particularly in the flagrantly biased and therefore inadequate reference lists. The structure of the book consists of opening chapters on setting up in practice, photography, local anaesthetic techniques, and a short but succinct chapter on wound healing which is well referenced and up to date. The remainder deals with specific procedures, entire chapters being devoted to dermabrasion, collagen fillers, chemical peeling, injection sclerotherapy, liposuction, and laser surgery, all of which contain the occasional useful snippet of information. However, further chapters on alopecia surgery, blepharoplasty, fat injection, and face and brow lifting are so inadequate as to make one question the seemingly impeccable credentials of the authors. The chapter on alopecia makes no reference whatsoever to tissue expansion, surely one of the most significant developments in this area in recent years. The chapter on brow lifting is similarly devoid of reference to the bicoronal approach. An entire chapter is devoted to autologous fat transplantation without questioning its highly dubious validity. These flagrant omissions are compounded by statements which reflect a thoroughly naive understanding of basic surgical techniques. The ‘recipe book’ approach which pervades the work would be a poor substitute for that knowledge of the behaviour of tissues when handled surgically which can only be gained by practical experience and teaching. Dermatological trainees who reach for this volume to guide their first attempts with cosmetic procedures have my sympathies for the pitfalls they will experience. They have been warned. The forte of this book is the detailed place given to descriptions of techniques which are peripheral to ‘mainstream’ plastic surgery, but of more concern to the comprehensive cosmetic practitioner. These might well make it a valuable source for those working in the cosmetic area who are less familiar with the variety of techniques which dermatologists have developed over the years. The descriptions of dermabrasion and chemical peeling are exhaustive, and indeed, the list of conditions for which the former is advocated as a cure-all is remarkable. The surgeon faced with patients demanding treatment for unsightly bikini-line hair or minor telangiectases on the legs will find scientifically based expositions on these and other areas which do not feature highly in a plastic surgeon’s training curriculum. However, none of this exonerates the work from its overall approach, which I believe stems from questionable motives in its
257 genesis. It is sad to find a book on this subject which only mentions our specialty in a disparaging way ; “ . . here is patient x, informed by 3 plastic surgeons that his case was too severe and would not respond.. . , dermabraded by dermatologist with marked improvement shown, etc, etc.“. My experiences with dermatological colleagues in this country have been invariably good, so I sincerely hope that this book is not a portent of things to come and that the volume is one export that stays firmly on the west side of the Atlantic. I cannot recommend it for libraries or plastic surgery trainees, despite its reasonable price, good pictures, and smart production. T. E. E. GOODACRE
Occupational Hand and Upper Extremity Injuries and Diseases. Edited by Morton L. Kasdan. (Philadelphia, Hanley & Belfus Inc., 1991). Pp. xxii + 580, Illustrated. ISBN l-5605-3002-2.
Price E50.00.
A successful outcome to the treatment of hand injury should be gauged by the patient’s ability to return to full employment. Seemingly minor injuries have produced devastating effects on hand performance. However well executed the surgery, it must be supported by physiotherapists and splint makers, but paramount to all this is patient motivation. In the absence of the latter, the surgical effort is doomed to failure. Morton Kasdan’s book addresses the psychology of the injured patient in some detail. Indeed, the introductory chapters are some of the most interesting. Chronic pain is a considerable drain on any country’s exchequer and time-consuming to an examining physician. In this age of the assembly line worker, hands perform very repetitive movements for hour after hour and not surprisingly, strain syndromes develop. The relationships of the strain syndrome to occupation are the main thrust of this presentation. Arguably, it might have been best to restrict the discussion to these groups and deal with them in depth, but for the sake of completeness, the text is extended to include fingertip electrical, tendon, and high pressure injection injuries, and fractures. The nerve compression syndromes, and factors both externally and internally which may produce them, are quite well covered and interesting reading, although they will be familiar to many and the theme comes back on track with tendonitis. Unfortunately, concerning the latter, and indeed with chronic pain which is the main reason for embarking on this 560 page read, one is left with unanswered questions. Multiple authors, although probably essential if a large canvas such as this is to be painted, do make for a rather superficial text and repetition is hard to avoid, e.g. Raynauds is considered in some detail in four different chapters. In conclusion : a nicely presented book approaching hand injuries from a different direction, relating occupation to the injury both physical and mental. The best chapters are those dealing specifically with the psychological consequences of injury and pain. D. H. HARRISON
Chirurgie des L&es. Edited by J. L&ignac. (Paris, Masson, Cditeur, 1990). Pp 269, illustrated. Price 660F. This compact book is written in French with, rather strangely, an English translation of the index but no translation of the text. It is a multi-author production edited by Dr Mvignac and apparently constructed under the aegis of the French Association of MaxilloFacial Surgeons. It is aimed at oral surgeons, ENT and plastic surgeons but it is not clear whether the intended readership is established practitioners or trainees. The book has a total of 269 pages and, apart from Dr Levignac, has a total of 29 contributing authors. The first 3 chapters deal with anatomy, embryology and vascularity of the lips. The existence and importance of the wet/dry junction is stressed, together with age variations in the lip, but overall the level of description is necessarily basic; for instance, there is little detail of the structure of the orbicularis oris muscle. The fourth chapter consists of a collection of repairs by Dr Levignac for various conditions from bums to cleft lips. The results are impressive but it is difficult to see where it fits in the overall plan of the book.
(1992). 45. 256-259
1992 The British Association of Plasic Surgeons
Book Reviews Colour Atlas of Aesthetic Surgery of the Abdomen. By Jorge M. Psillakis, Erdulfo Appiani and Rafael de la Plaza. Pp 1X+86. 73 Illustrations and Figures. (New York: Thieme Medical Publishers, Inc., 1991). Price DM148. ISBN O86571-343-2.
and the quality overall is good, though there are a few poorly exposed photographs included. Many plastic surgeons are not active in skeletal recontouring in the face. but for those who are, even if only for ‘deformity’ rather than ‘aesthetic’ problems, this is a useful and pleasant read. M. D. POOLE
Compared with other aspects of aesthetic surgery, very few books have been published on abdominoplasty. This book, with a foreword by Robert M. Goldwyn, aims “to present practical ways of performing an abdominoplasty, emphasizing the refinements which will attain beauty.. “. There are three main chapters which describe pre-operative evaluation, operative technique and post-operative management as practised by the authors. The broad range of aesthetic abnormalities with which patients present are usefully classified into six Types ranging from excess subumbilical fat only (Type 1) to large amounts of excess skin and fat together with laxity of the abdominal wall (Type V). Type VI patients are those with excess supra-umbilical skin who are best treated with a reverse abdominoplasty. The authors then describe how best the various surgical techniques can be applied to treat these Types with the aim of creating an appearance which approximates to the shape and contour of the ideal abdomen, which they define in the Introduction. They place particular emphasis on the value of using liposuction and external oblique muscle flaps (Psillakis and Appiani) to achieve normal appearance. The book is attractively presented and liberally illustrated with photographs and drawings, most of which are in colour and of excellent quality, but the text suffers somewhat from the quality of its translation into English. As a How-We-Do-It cook book on abdominoplasty, it succeeds but, alongside so many current publications on aesthetic surgery, this book is strikingly short of scientific objectivity in describing the outcomes of the several operative procedures which are advocated. Whilst complications are described, their incidences are not and no mention is made of the levels of patient satisfaction. A ‘Bibliography’ lists most of the important publications on abdominoplasty (and two unpublished titles given al symposia) but they are not referred to in the text. .4s this book presents a logical approach to the design and performance of abdominoplasties, it will be useful reading for surgeons who can input their own objectivity from personal experience. D. L. HARRIS
Handhook of Medicolegal Practice. Edited by John P. W. Varian. (Oxford, London, Boston, Munich, New Delhi, Butterworth-Heinemann Ltd., 1991). ISBN 0-7506-1238-X. Price: g19.50. Pp. ix+ 194, illustrated. The first time a medical practitioner encounters the law, apart from any personal extracurricular indiscretions, is usually as a registrar having been delegated a relatively straightforward medicolegal report by the consultant: yet there is little teaching or induction in order to prepare such a document, which may be of considerable importance in determining the fate of a plaintiff patient. The law relating to the practice of medicine and surgery is not adequately taught in medical schools at undergraduate or post graduate level and, although negligence is only one of the many facets of medical law, there is a need for a book giving medicolegal guidelines. The editor of the Handbook of Medicolegal Practice is a hand surgeon working exclusively in private practice in Dublin and opens with two chapters on how to make a report and how to behave in court, but in a flippant style which distracts from several good themes. Most of the other chapters are written by doctors representing their interests such as general practice, general surgery, obstetrics and gynaecology, orthopaedics, plastic surgery, otolaryngology and ophthalmology, and simply provide an incomplete litany of potential errors, complications and pitfalls which cannot be news for the relevant specialists. Those authors who do raise pertinent legal issues repeat what has already been said in the two best chapters; the first giving the lawyer’s view with an easily understood explanation of the principles of duty and standards of care, breach of duty and proof of medical negligence. The second clearly identifies how complaints arise, how to avoid them and what to do when they happen. However, every surgeon should read the chapter on anaesthetics which serves to emphasise the necessity of separate consent forms, one to be completed by the surgeon and the other by the anaesthetist. There is no doubt that this book fulfils a need but it could be so much better. There is too much repetition and overlap. For example, hand surgery is discussed by the editor, the orthopaedic surgeon and the plastic surgeon whereas it should be covered only by the invited hand surgeon who, incidentally, writes the best of the specialist chapters. The book can be recommended to any doctor on the strength of the two best chapters but any subsequent version could benefit from tighter editing (in its present form it tries to hit too many targets at too many different ranges), from a brief introductory chapter indentifying the goals more precisely and by a glossary of relevant legal and medicolegal terms. As a final section one might consider the weaknesses and occasional unfairness to patients of the present inordinately prolonged and labyrinthine system of seeking justice. There is no mention of no-fault compensation. C. M. WARD
Aesthetic Contouring of the Craniofacial Skeleton. Ed. Douglas K. Ousterhout. (Boston, Toronto, London, Little, Brown and Company, 1991). ISBN O-316-67410-9. Pp XXX + 576, ill. Price g195. This is a good book, and it is nice to see that a large work like this on aesthetic craniofacial surgery has been edited by such a respected practitioner of reconstructive craniofacial surgery as Dr. Ousterbout. The coverage is wide and takes in assessment, psychological considerations, surgical techniques and problems and complications. With the exception of rhinoplasty, most craniofacial skeletal recontouring procedures are included. While purely aesthetic procedures are described, much of the content is on surgery for what most would consider to be deformity. Discussion of conditions like hypertelorism. orbital dystopia, and syndromal deformities of the craniofacial skeleton is not present, however. Many surgeons active in this work from around the world have contributed. The content is divided up into sections on evaluation and diagnosis, materials for augmentation, surgical methods and long-term results, as well as an introductory section which includes an interesting chapter on cultural aspects of beauty. There are lots of illustrations. almost all black and white with just a few colour prints,
Procedures in Plastic and Reconstructive Surgery: How they do it. Edited by Lars M. Vistnes. (Boston, Toronto, London, Little, Brown and Company, 1991). ISBN O-316-90437-6. Pp xvi + 752. illustrated. Price f170. This book succeeds in its aim of detailing various operations of aesthetic and reconstructive surgery as performed by acknowledged experts mostly from North America. More than a third of the 256
Book Reviews book covers aesthetic operations, a fifth concerns the reconstructive surgery of congenital problems (but does not mention genital problems) and the rest is about reconstructive surgery of acquired problems. Its strength is in the very high standard of the text, the helpful and detailed diagrams and the general layout of the contents which makes reading it a pleasure, even on subjects which have been repeatedly written about in the past. The index is good, references are helpful and up-to-date. The weakness of this book for the British reader is the omission of several important procedures such as the surgery of hypospadias, pharyngoplasty, pressure sore surgery and the surgery of congenital hand abnormalities, Dupuytren’s disease and rheumatoid arthritis of the hand. Unfortunately the cost $170) is such that it will be beyond the means of most trainee plastic surgeons. Established plastic surgeons (for whom I am sure this book has been written) working in any of the many fields of plastic and reconstructive surgery will benefit from the up-to-date information so well presented and it will be a very useful addition to a Plastic Surgery Unit Library. D. S. MURRAY
Cosmetic Surgery of the Skin: Principles and Techniques. Edited by William P. Coleman III, C. William Hanke, Thomas H. Alt and Saul Asken. (USA, B. C. Decker Inc.; UK, Wolfe Publishing Ltd., 1991). ISBN 1-55664-176-l. Pp xii + 388, illustrated. Price E86.00. The purpose of this elegantly presented new multi-author book is to teach dermatologists the techniques of cosmetic surgery in which the specialty “ . . is beginning to define its role.. . “. The selection of material and manner of presentation make it something of a manifesto in its desire to restore to primacy the historical place of dermatologists in the development of cosmetic surgical techniques. Indeed, it is studious in its attempts to negate the contribution, and even existence, of plastic surgery in the historical preamble to each subject, in its approach to surgical technique, and particularly in the flagrantly biased and therefore inadequate reference lists. The structure of the book consists of opening chapters on setting up in practice, photography, local anaesthetic techniques, and a short but succinct chapter on wound healing which is well referenced and up to date. The remainder deals with specific procedures, entire chapters being devoted to dermabrasion, collagen fillers, chemical peeling, injection sclerotherapy, liposuction, and laser surgery, all of which contain the occasional useful snippet of information. However, further chapters on alopecia surgery, blepharoplasty, fat injection, and face and brow lifting are so inadequate as to make one question the seemingly impeccable credentials of the authors. The chapter on alopecia makes no reference whatsoever to tissue expansion, surely one of the most significant developments in this area in recent years. The chapter on brow lifting is similarly devoid of reference to the bicoronal approach. An entire chapter is devoted to autologous fat transplantation without questioning its highly dubious validity. These flagrant omissions are compounded by statements which reflect a thoroughly naive understanding of basic surgical techniques. The ‘recipe book’ approach which pervades the work would be a poor substitute for that knowledge of the behaviour of tissues when handled surgically which can only be gained by practical experience and teaching. Dermatological trainees who reach for this volume to guide their first attempts with cosmetic procedures have my sympathies for the pitfalls they will experience. They have been warned. The forte of this book is the detailed place given to descriptions of techniques which are peripheral to ‘mainstream’ plastic surgery, but of more concern to the comprehensive cosmetic practitioner. These might well make it a valuable source for those working in the cosmetic area who are less familiar with the variety of techniques which dermatologists have developed over the years. The descriptions of dermabrasion and chemical peeling are exhaustive, and indeed, the list of conditions for which the former is advocated as a cure-all is remarkable. The surgeon faced with patients demanding treatment for unsightly bikini-line hair or minor telangiectases on the legs will find scientifically based expositions on these and other areas which do not feature highly in a plastic surgeon’s training curriculum. However, none of this exonerates the work from its overall approach, which I believe stems from questionable motives in its
257 genesis. It is sad to find a book on this subject which only mentions our specialty in a disparaging way ; “ . . here is patient x, informed by 3 plastic surgeons that his case was too severe and would not respond.. . , dermabraded by dermatologist with marked improvement shown, etc, etc.“. My experiences with dermatological colleagues in this country have been invariably good, so I sincerely hope that this book is not a portent of things to come and that the volume is one export that stays firmly on the west side of the Atlantic. I cannot recommend it for libraries or plastic surgery trainees, despite its reasonable price, good pictures, and smart production. T. E. E. GOODACRE
Occupational Hand and Upper Extremity Injuries and Diseases. Edited by Morton L. Kasdan. (Philadelphia, Hanley & Belfus Inc., 1991). Pp. xxii + 580, Illustrated. ISBN l-5605-3002-2.
Price E50.00.
A successful outcome to the treatment of hand injury should be gauged by the patient’s ability to return to full employment. Seemingly minor injuries have produced devastating effects on hand performance. However well executed the surgery, it must be supported by physiotherapists and splint makers, but paramount to all this is patient motivation. In the absence of the latter, the surgical effort is doomed to failure. Morton Kasdan’s book addresses the psychology of the injured patient in some detail. Indeed, the introductory chapters are some of the most interesting. Chronic pain is a considerable drain on any country’s exchequer and time-consuming to an examining physician. In this age of the assembly line worker, hands perform very repetitive movements for hour after hour and not surprisingly, strain syndromes develop. The relationships of the strain syndrome to occupation are the main thrust of this presentation. Arguably, it might have been best to restrict the discussion to these groups and deal with them in depth, but for the sake of completeness, the text is extended to include fingertip electrical, tendon, and high pressure injection injuries, and fractures. The nerve compression syndromes, and factors both externally and internally which may produce them, are quite well covered and interesting reading, although they will be familiar to many and the theme comes back on track with tendonitis. Unfortunately, concerning the latter, and indeed with chronic pain which is the main reason for embarking on this 560 page read, one is left with unanswered questions. Multiple authors, although probably essential if a large canvas such as this is to be painted, do make for a rather superficial text and repetition is hard to avoid, e.g. Raynauds is considered in some detail in four different chapters. In conclusion : a nicely presented book approaching hand injuries from a different direction, relating occupation to the injury both physical and mental. The best chapters are those dealing specifically with the psychological consequences of injury and pain. D. H. HARRISON
Chirurgie des L&es. Edited by J. L&ignac. (Paris, Masson, Cditeur, 1990). Pp 269, illustrated. Price 660F. This compact book is written in French with, rather strangely, an English translation of the index but no translation of the text. It is a multi-author production edited by Dr Mvignac and apparently constructed under the aegis of the French Association of MaxilloFacial Surgeons. It is aimed at oral surgeons, ENT and plastic surgeons but it is not clear whether the intended readership is established practitioners or trainees. The book has a total of 269 pages and, apart from Dr Levignac, has a total of 29 contributing authors. The first 3 chapters deal with anatomy, embryology and vascularity of the lips. The existence and importance of the wet/dry junction is stressed, together with age variations in the lip, but overall the level of description is necessarily basic; for instance, there is little detail of the structure of the orbicularis oris muscle. The fourth chapter consists of a collection of repairs by Dr Levignac for various conditions from bums to cleft lips. The results are impressive but it is difficult to see where it fits in the overall plan of the book.