The population of Irrawaddy dolphins that occupies the Mekong River in southern Lao People's Democratic Republic and Cambodia is classified as Critically Endangered by the IUCN. Based on capture-recapture of photo-identified individuals, we estimated that the total population numbered 93 +/- SE 3.90 individuals (95% CI 86-101), as of April 2007. The combined photo-identification and carcass recovery program undertaken from 2001 to 2007 established that the Irrawaddy dolphin population inhabiting the Mekong River has reached a critical point with regards to its continued survival, where immediate research and management actions are required to greatly reduce adult mortality, and establish the cause of newborn mortality. In addition, community consultation is required to initiate, and evaluate, urgently required conservation measures. An ongoing well-designed combined program of abundance estimation (i.e., photo-identification) and carcass recovery is required to monitor total population size and mortality rates, to inform and evaluate management initiatives. The conclusions of this paper are likely generic to river dolphin populations, particularly where photo-identification is possible.

Type of Book: A historical account of the development of a surgical department at a major university.

OBJECTIVEThe purpose of the study is to define those patient variables that contribute to morbidity and mortality of median sternotomy wound infection and the results of treatment by debridement and closure by muscle flaps.BACKGROUNDInfection of the median sternotomy wound after open heart surgery is a devastating complication associated with significant mortality. Twenty years ago, these wounds were treated with either open packing or antibiotic irrigation, with a mortality approaching 50% in some series. In 1975, the authors began treating these wounds with radical sternal debridement followed by closure using muscle or omental flaps. The mortality of sternal wound infection has dropped to < 10%.METHODSThe authors' total experience with 409 patients treated over 20 years is described in relation to flap choices, hospital days after sternal wound closure, and incidence rates of morbidity and mortality. One hundred eighty-six patients treated since January 1988 were studied to determine which patient variables had impact on rates of flap closure complications, recurrent sternal wound infection, or death. Variables included obesity, history of smoking, hypertension, diabetes, poststernotomy septicemia, internal mammary artery harvest, use of intra-aortic balloon pump, and perioperative myocardial infarction and were analyzed using chi square tests. Fisher's exact tests, and multivariable logistic regression analysis.RESULTSThe mortality rate over 20 years was 8.1% (33/49). Additional procedures for recurrent sternal wound infection were necessary in 5.1% of patients. Thirty-one patients (7.6%) required treatment for hematoma, and 11 patients (2.7%) required hernia repair. Among patients treated since 1988, variables strongly associated with mortality were septicemia (p < 0.00001), perioperative myocardial infarction (p = 0.006), and intra-aortic balloon pump (p = 0.0168). Factors associated with wound closure complications were intra-aortic balloon pump (p = 0.0287), hypertension (p = 0.0335), and history of smoking (p = 0.0741). Factors associated with recurrent infection were history of sternotomy (p = 0.008) and patients treated for sternal wound infection from 1988 to 1992 (p = 0.024). Mean hospital stay after sternal wound reconstruction declined from 18.6 days (1988-1992) to 12.4 days (1993-1996) (p = 0.005). To clarify management decisions of these difficult cases, a classification of sternal wound infection is presented.CONCLUSIONSUsing the principles of sternal wound debridement and early flap coverage, the authors have achieved a significant reduction in mortality after sternal wound infection and have reduced the mean hospital stay after sternal wound closure of these critically ill patients. Further reductions in mortality will depend on earlier detection of mediastinitis, before onset of septicemia, and ongoing improvements in the critical care of patients with multisystem organ failure.

This text addresses a relatively new concept in rhinoplasty, open structure procedures. The book is divided into four parts. Part 1 begins with fundamentals, including a review of the concept of open rhinoplasty and an excellent chapter on the surgical anatomy and physiology of the nose that features photographs of cadaveric dissections. A final chapter discusses nasal esthetics. Part 2 covers anesthesia and the basic technique of open structure rhinoplasty. Part 3 reviews clinical applications in relationship to specific anatomic areas—the lower third of the nose, the upper two-thirds, and a special chapter on tip grafting. An additional chapter on chin augmentation and revision rhinoplasty is included. Part 4 offers case studies representative of both primary and revision rhinoplasties.

Dr. Shaw has again demonstrated his outstanding talents by joining his expertise and experience with that of a former student and colleague, Dr. Hidalgo, and producing a work that most certainly is, as mentioned in the foreward, “a permanent addition to our surgical knowledge and… foundation for future reconstructive microsurgery.”

Ten topics related to photography in plastic surgery are covered in this 150-page-plus book. A general discussion of the photography of patients is provided by Nelson in a concise introductory chapter. Four additional chapters deal with photographic equipment including the camera and lens, light and metering, film, and projection equipment and design. These contributions are brief but informative and seem to cover all the important points. The remaining topics include editing and slide sorting, as well as ethical considerations in the medicolegal aspects of photographing patients and photographic record keeping.

This monumental work has 137 contributors from all over the world (at least 16 countries other than the United States are represented). The two volumes of this 1,530-page publication consist of the following 11 sections: the scalp and skull, skin, orbit and adnexa, ear, nose, buccal and parotid area, facial bones, lips and chin, oral cavity and pharynx, neck, and, finally, anesthesia. All sections have the same format; the topics addressed are anatomy and physiology, embryology, developmental defects, pathology, trauma, aesthetic results, and, finally, reconstructive considerations. The text is clearly written and nonexcessive, and each section is followed by an excellent list of references. The illustrations are clear, uncluttered, and appropriately positioned in the text. Despite a rigid outline, which is easy to follow, the separate sections and subsections have their own “personalities” because of variations in the writing styles of the authors. Throughout the book, however, the main theme is maintained.

This 125-page manual is divided into 12 chapters. The first three chapters deal with education of the plastic surgeon, selection of patients, and sedation for esthetic surgical procedures. The remaining nine chapters describe one method of performing eight surgical procedures plus dermabrasion, chemical peel, and collagen injection. The procedures include augmentation and reduction mammaplasty, abdominoplasty, blepharoplasty, facelifting, and rhinoplasty. The chapter format is as follows: (1) indications, (2) contraindications, (3) “what the patient needs to know,” (4) “what the surgeon needs to know,” and (5) operative design, technique, and variations.

Sacral soft tissue defects from 10 to 18 cm in diameter were closed with gluteus maximus musculocutaneous V-Y advancement flaps in 17 patients. Defects were secondary to pressure, radiation injury, or tumor resection and occurred in both ambulatory and nonambulatory patients. Technique varied according to the size of the ulcer and the ambulatory status. This musculocutaneous unit advanced in a V-Y fashion provides well-vascularized tissue for coverage of large sacral defects. It allows for restoration of normal contour, with primary closure of the donor site. Ambulatory patients noticed little or no functional deficit.

The surgical rehabilitation of a patient with severely deformed and functionally disabled genitalia due to long-standing lymphedema and infection is described and illustrated. The term "elephantiasis" has been applied to such gross lesions. Appropriate surgery to the penis, scrotum, and perineum has yielded a gratifying result. The principles and techniques of the surgical approach in such an undertaking are presented and discussed.