264 BRITISH JOURNAL OF PLASTIC SURGERY

mental library. If you are a surgeon who takes a pride in your ability to reconstruct any defect, from the sole of the foot to the top of the head, you will want to buy this book, despite its high price.

ALAN G. LEONARD

The Musculo-Skeletal System: Embryology, Biochem- istry and Physiology. By Richard L. Cruess. Pp 397 with illustrations. (Edinburgh, New York: Churchill Living- stone, 1982). Price f45.00.

The first impression is of a well-produced book with clear print on good paper in the convenient size of lO”x7”. The illustrations of photomicrographs are quite superb, clearly labelled and presented with comprehensive legends and appro- priate cross-reference in the text. Although American, the format is conventional and has not adopted the trans-Atlantic custom of arranging the text into two columns per page. Indeed, there are few Americanisms overall, merely the odd use of words such as “perturbations” and “osteopenic” and oc- casional spelling differences that are inoffensive. The title is a true reflection of the contents of the book, although it should be noted that as there are only 33 pages on muscle and the equivalent (or less) on nerves and tendons, the emphasis is quite definitely on the biochemistry and physiology of bone and cartilage.

As a book mainly concerned with the workings of the skeletal system at a cellular level one of your reviewers (G.C.) found it admirable and well suited to his work as an anatomist involved in pre-clinical teaching: but for whom is it intended? Your other reviewer (G.L.) found that with the emphasis of the book pitched at the cellular level, it was less admirable, despite his personal interest in microsurgery. Those sections which would be of more interest, namely on muscles, nerve and tendon are given too little space and although comprehensible are by no means comprehensive.

The aim of the work, as indicated in the preface, is to organise the vast body of knowledge concerning the musculo- skeletal system in such a way as to make it comprehensible to someone “in training for a clinical discipline or practising a speciality”. By this we take it to mean medical graduates pursuing further specialist training, for although it would be true to say that medical students are also “in training” for an eventual clinical discipline, we think the book is too detailed for them. Furthermore, it reads like many rather boring scientific papers and there are few oases of description to refresh the weary traveller. Interestingly, those that do occur, for instance the description of osteoclasts as “cytologic streetcleaners”, chondrocytes in the proliferative zone of the epiphyseal plate as “stacked in coin-like columns” and acting as “hydraulic jacks” with the resultant bony funnels growing like “a stack of empty ice cream cones”, all appear in the chapter on embryology and development of the skeletal system and this is the one chapter one would recommend students to read.

If the book is really aimed at practising clinicians it is a pity that there are not more clinical correlates and virtually no relevant syndromes are mentioned other than in the chapter on muscle. The very short chapter on tendons (10 pages) concen- trates only on flexor tendon healing in the hand. Thechapter on

nerves would have been of greater value had it been expanded. The other 9 chapters concerning the various structural elements of the skeletal system, their growth and hormonal control, are straightforward reviews of the relevant biochemistry and physi- ology. The clinical aspects are but lightly touched on and some, such as electrically-stimulated osteogenesis, deserve more space.

The chapter on the structure, organisation and healing of bone is good with 294 references listed and a useful section for clinicians on dysfunctional bone remodelling. The equivalent chapter on cartilage has an interesting section on the repair capacity of articular cartilage in a variety of experimental situations.

The references are comprehensive and up-to-date. Several aspects of skeletal research of limited interest, for example, bone morphogenetic protein (BMP), the osteocalcins, the inter-relationship between Vitamin K and bone, to mention but a few are not listed in the index but are alluded to in the text with further sources of information indicated. It can thus be seen that this is an advanced text, ideal for those who want an overview of skeletal research. One of us (G.C.) is very pleased to have this book and hopes that Churchill Livingstone will produce a series of similar books: such dissertations on the embryology, biochemistry and physiology of the vascular system and of the skin are far more likely to be welcomed by plastic surgeons.

G. C. CORMACK B. G. H. LAMBERTY

Clinical Applications of Biomaterials. By A. J. C. Lee, T. Albrektsson and P.-l. Branemark. Pp 356 with 138 illustrations. (Sussex: John Wiley and Sons Limited, 1982). Price f27.50.

This volume reports the material presented at the Second European Conference on Biomaterials held in Gothenberg, Sweden in 1981. The volume includes 335 pages and the 39 articles each about eight pages long on average, including the diagrams and references. This is not therefore a volume reporting sophisticated analyses or wide ranging control tests, rather the emphasis is on short presentations of preliminary data relating to clinical applications of biomaterials.

The first 13 chapters are under the general heading of orthopaedics and relate to metals, carbon fibre, and other carbon based materials, ceramics, acrylic resin, polymethyl- methacrylate and cyanoacrylates. Of the 13 papers in this section, 7 related to tests on animals and 6 were laboratory bench tests, some related to mechanical analysis also. Generally the authors were looking at problems of replacement of human anatomical structures, such as ligaments, tendons and joints and in almost every case the techniques still had to be subjected to the greater imponderable of trials in man.

The second section of the book comprises nine chapters relating to developments in dentistry and related fields; 3 of these were animal studies, one a laboratory analysis and 5 related to the performance of humans, particularly in respect of implants of titanium and gold in the dental region. Six of these papers came from institutions in Gothenberg and Linkoping. These related to the use of titanium as a percutaneous structure