108 BRITISH JOURNAL OF PLASTIC SURGERY

T h e G e n e r a l a n d P l a s t i c S u r g e r y o f t h e H a n d . By PATRICK CLARKSON and ANTHONY PELLY. Pp . x i v + 4 2 8 , wi th 191 i l lustrat ions. ( O x f o r d : Blackwell Scientif ic Publ ica t ions . 1962). s s.

The surgery of the hand has developed rapidly during the last twenty years. Mr Patrick Clarkson, the senior author, is well known for his pioneering methods in the Casualty Department at Guy's Hospital, and this new book on hand surgery is a welcome addition to those that are already available.

The book is intended as " a practical guide for young surgeons--general, orthopmdic, and plastic--especially in the primary treatment of trauma." A large section of many chapters is devoted to the management of all types of hand injuries, including burns. All structures of the hand are considered, but tile principles and methods of skin closure in different types of injury receive particular emphasis. Trained plastic surgeons are not readily available in many Casualty Departments, and a little rearrangement of the text with the addition of more detailed instructions on the care of skin grafts, flaps, and donor sites would increase the value of the book for those who lack a basic training in plastic surgery. The section devoted to late reconstructive procedures provides a good review of this aspect of hand surgery, and it indicates what can be achieved without overloading tile ~ext with excessive detail~ The after-care of hand injuries is important and a separate chapter is desirable. More information on active exercises might be provided, as many patients with less serious injuries are capable of doing their own physiotherapy when given adequate instructions. The final section contains chapters on Dupuytren's disease, rheumatoid arthritis, infections, tumours, and congenital anomalies. A useful feature of the book is the bibliography of selected references given at the end of each chapter.

The book is well produced and is very well illustrated, although several of the illustrations have been reduced so much that essential detail is obscure. The illustrations are numbered separately in each chapter and the inclusion of a page number at a cross-reference would make the illustration referred to much easier to find. Misprints are infrequent, but one can admire the fortitude of the patient who maintained the foot-hand attachment for four to six months. I t is inevitable in a relatively small book based on the authors' own experience that there will be some differences of opinion, but the criticisms and suggestions that have been made are of a minor nature and do not detract from the value of the book. It succeeds in its aim of providing a practical guide to the treatment of hand injuries and will be a source of much useful information in all Casualty Departments. A . C . B .

Plastic S u r g e r y . By RICHARD B. STARK, M . D . Pp . 718, w i t h i l lustrat ions. ( N e w York : H a r p e r & Row. 1962.) s 8s,

This handsome, generously illustrated textbook is largely the work of one surgeon, a fact which unifies its character and by no means restricts its scope.

The problems of plastic surgery, which are so difficult to break down for textbook purposes, are handled mainly on a regional basis. But earlier sections on basic techniques, and a chapter on the skin, include the essential fundamentals--both operative and pathological.

Most of the detail is admirable ; the chapters on skin flaps, on the lip, and on the nose are helpful, clear, and emphasise the realistic approach of a surgeon fresh from the theatre rather than the library. There are wise and helpful sections on research and on embryology, the latter being a field in which the author has already done important original work. Certain points, however, invite criticism : often the lucid and artistic drawings are divorced from the related text ; some of the photographs (especially of the hand) are of inferior quality ; there are some sad slips in the spelling of names ; on its first five appearances Tenuison's name is given an oddly poetic designation, is missing (in any version) from the appropriate bibliography, but occurs in both variants in the index.

Many sections have an interesting historical introduction, but again mistakes occur ; Gallie's use of fascia is dated fifteen years late, while Par6 is put ill the wrong century. Dr Stark is widely versed in the views of surgeons outside the U.S.A.~ and this is reflected, frequently and happily, in the text. But some readers will disagree with certain recommendations : the use of skin flaps for resurfacing the palm ; the indications for Wolfe grafts in Dupuytren's contracture ; the alleged limitations in size for large dermis-fat grafts in augmentation of small breasts ; the routine use of a nipple transplant in mammaplasty, and of a pharyngeal flap in primary palate surgery done near the first birthday ; the implication that the Hughes operation for reconstructing the lower lid is applicable m the upper lid--all these issues are open to serious question.

The main criticism is that some younger readers may be confused with a plethora of op.erative alternatives, each presented with similar emphasis ; this is most marked in the section on hypospadias. But most of the blemishes noted are minor. For this is an outstanding work--detailed, erudite, practical, and above all readable. And it may well be recognised--at least for the present - - as the most successful attempt to cover, in a single volume, the whole broad field of this cowplex branch of surgery. C . R . McL.