BOOK REVIEWS

SYMPOSIUM ON RECONSTRUCTIVE HAND SURGERY. Edited by LITTLER, CRAMER and SMITH. Pp. v+324, with 458 illustrations. (St Louis: The C. V. Mosby Company, 1974.) Price E20.20.

The volume is the 9th in the series of symposia published by the Educational Foundation of the American Society of Plastic and Reconstructive Surgeons and it records the contributions given by the 35 authors to the Symposium on Hand Surgery held in November, 1972, jointly with the American Society for Surgery of the Hand. One of the previous published Symposia was on the same subject and the format and general style are generally similar. itself to specific topics.

As before it does not provide systematic coverage, but confines

in interest. In so doing it becomes something of a “lucky bag” since the topics chosen vary

The fact that some of the contributions lack interest implies no criticism of the author of the particular chapter since the author writes on the topics chosen for him rather than the one of his own choice. If the topic is not one to raise a spark in his reader that is the author’s misfortune rather than his fault and one must sympathise. The blame really lies with whoever made the choice. Here some criticism can be made. At least four of the contributors have written virtually the same paper in the not too distant past, while other contributions are too full of observations already well documented in other texts.

The senior editor, to the great pleasure of this reviewer at least, has given his illustrative talent greater rein than usual. for three more.

Not merely has he illustrated his own three chapters but has provided the line drawings His own chapters pursue topics which he has already considered in previous publications,

but on this occasion he has taken each a stage further. A volume of this type treads a difficult path in trying to provide something for everyone. The result

is apt to be a mixture of old and tried topics with new and untried methods. Non the less there is the occasional contribution in which a definitive assessment of a problem is attempted. Thumb reconstruction is such a subject. On one side Littler stresses the virtues of digital transposition; balanced by Murray with his more cautious and carefully reasoned comparative assessment of the various methods available.

It is of interest incidentally to note the topics which have been left out. Rheumatoid arthritis seems to be having a rest? which some might say was a relief!

An entire section is given to “What’s New” and another to “Techniques in Microsurgery”. Neither of these is entirely satisfactory. The topics chosen for the first are possibly not the best; the second requires fuller treatment to be really successful.

None the less, on the whole the book represents an up-to-date discussion of the subjects it covers and it should be read widely. Doubtless it would be but for its price. The time has surely come for publishers to curb rhe lavishness of their productions and reduce their price. may question whether the book merits the cost.

Even libraries in this country

its purchase? How much more so will the individual contemplating

I. A. MCGREGOR

COLPOPOIESIS FROM THE COLON. By M. KUN. Pp. 172 with 122 illustrations. (Budapest, Akademiai Kiado, 1975.) Price Ic;4-60.

Patients with vaginal aplasia may be treated by plastic surgeons, gynaecologists or general surgeons and the individual approach may be very different. Plastic surgeons have tended to rely on that most difficult procedure, the creation of a skin graft lined cavity. Good functional results can be obtained but at the expense of many months discomfort from indwelling contracture-preventing moulds. Gynaecologists and general surgeons have commonly used a length of gut, the former being occasionally accused by the latter of not-so-good results because they were unaccustomed to handling bowel. Most of the early bowel transplants were of small intestine and apart from intra-abdominal complications, the new vagina had unsatisfactory features such as abundant discharge particularly when eating and strong peristalsis when mechanically stimulated, sufficient to cause referred epigastric pain during intercourse.

Professor Kun, who is Professor of Surgery in the Second Department of Surgery of the Postgraduate Medical School in Budapest, believes and makes out an excellent case that a portion of the large bowel is the ideal transplant. ascending colon.

He uses either the sigmoid or, if that is not long enough or otherwise unsuitable, the

colon in 12. Of a series of 39 vaginal reconstructions the sigmoid was used in 27 and the ascending

The striking feature is that no contracture occurs and there is no need for moulds. The transplantation is so arranged that peristalsis proceeds from within out and there is no build up of secretions. Peristalsis does not appear to interfere with intercourse and indeed might be an asset.

The techniques described are not for the average plastic surgeon but there is much in the book that is relevant to any technique of repair, particularly in respect of patient handling. There is too an excellent review of all techniques of vaginal reconstruction. misused word makes the meaning obscure.

The English is good although very occasionally a

T. GIBSON

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