BOOK REVIEWS 245

United States and Great Britain, this is not a very satisfying chapter for British readers. It is clear that there is much more fragmentation in the United States than there is in the United Kingdom and one realises the many advantages which our much maligned services for health and social security provide for the overall management of patients with severe bums.

IAN F. K. MUIR

THE MANAGEMENT OF COMPLICATIONS IN OPHTHALMIC PLASTIC SURGERY. Edited by DAVID B. SOLL AND RIVA LEE ASBELL. Pp. 379, with 270 illustrations. (Birmingham, Alabama: Aesculapius Publishing Company, 1976.) Price $55.00.

This beautifully appointed large format book is another example of the trend towards publications dealing with complications and their management. It is edited by 2 ophthalmic surgeons and includes contri- butions by 13 other authors of the same specialty, I radiologist, 2 plastic surgeons and 4 ophthalmic plastic surgeons.

It contains more than its title implies; starting with 2 excellent chapters on the anatomy of the orbital region and on the diagnostic techniques in orbital surgery, it ends, as often is the case with Transatlantic contributions, with a chapter on the psychological and legal considerations in ophthalmic plastic surgery.

This book acquaints the plastic surgeon with the thinking and views of his ophthalmic colleagues on common grounds, such as lacrimal drainage surgery, blepharoptosis, entropion and ectropion. The latter 2 subjects are dealt with together in a particularly comprehensive chapter. Deep orbital surgery and bony orbital lesions also make worthwhile and instructive reading. However, the chapter on cosmetic blepharo- plasty does not include the now widely practised surgery for the oriental eye.

It is unfortunate that a work of this nature has not been more of a joint venture between ophthalmic and mastic suraeons to the mutual benefit of both soecialties. The auestion arises whether we are com- plac&tly watching bits of our specialty being nibbied away on anatomical and pathological grounds by other disciplines. Perhaps a book contributed by the same authors on “The treatment of ophthalmic complications in plastic surgery” would have been more welcome.

This however, should not distract from the obvious effort of the editors and contributors in producing a clearly laid out and superbly illustrated book full of useful information. It will certainly be a worthwhile addition to the departmental and reference library of plastic surgery units.

M. N. SAAD

SKIN FLAPS. Edited by WILLIAM C. GRABB and M. BERT MYERS. Pp. xxix 548 with 4Ig illustrations. (Boston: Little, Brown and Company, 1975.)

This book is dedicated to the late Stuart H. Milton who in the middle 1960s carried out his classical experiments on skin flaps in pigs. His insistence that skin tlaps survived to the same length whatever their breadth was at first rejected by plastic surgeons who knew from bitter experience that to cut a flap on the trunk or limbs longer than its breadth was to invite necrosis. Then came the realisation that flaps with quite different blood supplies were involved; Ian McGregor christened them axial pattern and random pattern. Milton’s gaps were axial patterned and most human skin flaps were random patterned. But there were axial patterned gaps to be found on the human body too and the next logical step was to transfer such flaps bv direct microvascular anastomosis.

Milton’s studies therefore, although they still need a full reassessment, sparked off a revolution in skin flap surgery. Today the miseries of the migrating tube pedicle, of the cross-leg and other direct flap transfers, are almost but not auite over and this book has had to deal not only with the classical flaps of the past but also the more recent %nnovations. The first quarter of the book discusses research aspe& of skin flaps and is mostly articles by those who have carried on Milton’s studies. These animal experiments are interesting. They confirm much of what is known clinically but so far have not provided any method of saving the about-to-necrose flap.

The remainder of the book describes flaps of every variety arranged according to the various regions of the body. There are no less than 50 authors writing the chapters and the variations in style and presenta- tion are great. In general the topic of each is one on which he has already written and so, much of the work is already available elsewhere in the literature; it is valuable of course to have it all collected within the same covers. The book is exhaustive and as a source of reference will be of nermanent value. In their n&ace, the Editors say that the “plastic surgeon should consider all methods o’f producing skin coverage abd then pick. . . the simplest and surest”. Their book may well help him to do so if he is not utterly bewildered by the plethora of possibilities.

T. GIBSON