BOOK REVIEWS

The Palmar Fascia. By H. GRAHAM STACK. burgh and London: Churchill Livingstone, 1973).

Pp. vii+236, with 27 Illustrations. (Edin- Price E8.00.

The subject of this monograph has been an interest of the author for many years and it provided him with material for the Hunterian Lecture in 1970. Indeed, the present text is really an expansion of this lecture, which itself was based on an examination of serial sections of foetal hands made available to the author for study by Professor Landsmeer at the Anatomy Department of the University of Leiden. This, coupled with straightforward anatomical dissection and observations during the surgery of Dupuytren’s contracture, are the sources used by the author in this volume.

The book is in two parts. In the first part, the author describes in very great detail the anatomical changes in the various transverse sections of the hand, passing from the mid-palm to just distal to the web. This is followed by an analysis of his observations, his anatomical conclusions and their application fo Dupuytren’s contracture.

The second and longer part of the book reproduces the previous literature. This consists of the in extenso, translated and edited, writings on the subject of the palmar fascia of some 30 authors, from Albinus in 1734 right up to the present day.

There is no doubt that this book contains an extraordinarily full account of the anatomy of the palmar fascia and its thickenings in Dupuytren’s contracture, but the reviewer emerged from reading it a little bruised from rhe sheer weight of detail and inevitable repetition, particularly since much of the first half is repeated many times over in the second half as each of the 30 authors provides his own description of the fascia under discussion.

The reader might with profit have been spared much of the evidence on which the subsequent analysis and conclusions are based. This part of the book is more suited to a CbM. Thesis than a monograph. The analysis and conclusions are ihe meat of the book and they are contained in 30 pages. This-is ihe part relevant to surgical practice the part likely to be of most interest to the surgeon as opposed to the anatomist.

I. A. MCGREGOR

Plasties Mammaires pour Hypertrophie et Ptose. By J.-P. LALARDRIE and J.-P. JOUGLARD. Pp. 188 with 90 illustrations. (Paris: Masson et Cie.).

This book has appeared most opporrunely; the literature on mammaplasty has expanded exponentially in recent years and the authors have performed a great service to plastic surgery in collecting and reviewing it so thoroughly. There are almost 500 references and they are right up to 1973.

The first chapter deals with the anatomy and shape of the “normal” breast. They conclude that there is no “ideal form What is important is that it should be of pleasing form and free of prosis.” A breast volume around 2;~ ml. is about right: below 200 ml. the breast looks underdeveloped; above 350 ml., while attractive to some, the risk of early ptosis increases. The second chapter attempts to describe and define what is meant by mammary hypertrophy and mammary ptosis. Such definitions and that of “normality” are of course arbitrary but a great deal of wisdom is distilled in these chapters. The authors go on to describe the wide variety of mammaplasty techniques which have been published, how modern ideas gradually evolved, and the indications for each, and the results. This part of the book is mainly illustrated by simple but effective line drawings and one can rapidly compare the different techniques, such items as the shape and extent of the area which is de-epithelialised, the site from which the excess breast tissue is excised, the way in which the remaining breast tissue is rearranged and so on. There are, however, before and after photographs of the most commonly used techniques of the present time; courageously they have published almost as many photographs of poor results to illustrate how not to do it.

There is a good summary in English at the end of each chapter and the captions appear in both French and English. These and the very clear drawings make the book available to a much wider reader- ship than those who can easily read French. It is strongly recommended to every plastic surgeon who is concerned with the aesthetic surgery of the human breast.

T. GIBSON

The Artificial Larynx. By YVAN LEBRUN. Pp. 90, with 68 illustrations. (Amsterdam: Swets and Zeitlinger B.V.) Dutch guilders 25.-

This is a fascinating account of man’s efforts past and present to restore normal speech to patients whose larynx has been removed. The first gadgets a century ago attempted to lead vibrating air from the tracheostomy tube directly through a tube into the pharynx. But preventing food from entering the apparatus was a problem and external pneumatic devices were evolved and are still in use. They all

BOOK REVIEWS I99

consist of a device which will vibrate at approximately the frequency of the human voice and which is connected to the tracheostomy tube. From the vibrator a tube leads into the mouth where the vibrating column of air can be modified into speech. In some cases the frequency can be raised or lowered depending upon the force of expiration and a case is cited of a priest who uses such a device to preach each Sunday; not only can he preach with it? he can sing!

The alternative approach IS to introduce only a vibrating tone into the oral cavity. Tiny loud speakers set into upper dentures, realistic looking tobacco pipes containing batteries and vibrators, and hand-held vibrators pressed against the outside of the pharynx have all been tried and the latter two are still in use. Intelligible speech can be achieved but it is flat and monotonous and the sound “H” which requires a flow of air cannot be obtained.

This is a well written informative book in which the writer pays the reader the compliment (undeserved in the present case) of being fluent in French, German and Spanish and he quotes without translation from papers in these languages.

It may be read in an hour or two and should be by all who have to care for the laryngectomised patient.

T. GIBSON

Fortschritte der Kiefer- und Gesichts-Chirurgie, Volumes 16 and 17. Primary and Secondary Treatment of Clefts of the Lip and Palate. Edited by K. SCHUCHARDT, G. STEINHARDT and N. SCHWENZER. Pp. 392 with 388 illustrations. (Stuttgart: Georg Thieme Verlag, 1973.) DM. 270.

Volumes 16 and 17 of the Fortschritte are bound together and are the proceedings of the 1970 and 1971 congresses of the Deutsche Gesellschaft fiir Kiefer- und Gesichtschirurgie which were devoted to the primary (1970) and secondary (1971) repair and reconstruction of clefts of the lip and palate.

The last Fortschritte which had as its main theme cleft lip and palate surgery was Volume I published in 1955 and much water has flowed under the arch since then. In Volume I Nordin and Johansson for example presented z cases in which they had used bone grafts to reconstruct secondary palatal deformities; this and the contemporary activity of Eduard Schmid sparked off the enthusiasm for primary palatal bone grafting which subsequently reached such a pitch that it became almost unethical to repair a cleft palate without a bone graft. In the current volume Stellmach sketches the history of primary bone grafting “from the idea to the reality after a decade” and tells how one after another of the initiators gave it up.

This of course highlights the great difficulty of assessing any treatment of cleft lip and palate in much less than 20 years and is one reason why this volume is so valuable. As another example Herman Schweckendiek described in Volume I his technique of palate repair in which only the soft palate is closed in infancy, the hard palate being repaired at age 11-12. Now his son Wolfram is able to review 464 cases treated thus, 124 of which are 1-j or more years old.

There are 108 authors who cover virtually every aspect of cleft lip and palate rehabilitation and it is impossible to comment individually. I must refer, however, to the continuing ingenuity of Eduard Schmid who describes the use of a tongue flap for the same purpose as an Abbe flap. He has also recon- structed a columella with a tongue flap wrapped around a piece of cartilage. In both instances of course the mucous covering of the tongue was later excised and replaced with a full thickness skin graft.

This volume is almost as comprehensive as a textbook and contains a wealth of reasonably up to date information; it should be available to all who are concerned with care of the cleft child. It seems a pity however that the practice of having a short English summary of each chapter has been abandoned.

T. GIBSON

Symposium on the Treatment of Burns. Edited by J. B. LYNCH and STEPHEN R. LEWIS. Pp. xii + 253 with 339 illustrations. (St Louis, The C.V. Mosby Company, 1973.)

This book is Volume 5 in a series of symposia of the Educational Foundation of the American Society of Plastic and Reconstructive Surgeons.

If fulfils the objective stated in the preface of providing a concise, current summary of the treatment of burns. All aspects are dealt with from the pathophysiology through the actual stages of early treatment to methods of reconstruction of post-burn deformities.

The chapters concerned with fluid management and involvement of the respiratory tract are very useful and the chapter on renal considerations provides a good basis for understanding the problems of renal failure in burned patients.

Infection is dealt with thoroughly, the varying regimes of topical applications, patient isolation and septicaemia are fully discussed.

Due emphasis is given to allograft coverage of the burn, with mesh-autografting and skeletal suspension described. The present status of synthetic materials as dressings is also dealt with.

The last quarter of the volume deals with the more common post-burn problems in a short and helpful way.