Textbook of Plastic and Reconstructive Surgery: Basic Principles and New Perspectives

Foreword 1
Foreword 2
Preface
Contents
List of Videos
Part I: Principles in Plastic Surgery
	1: Anatomy and Physiology of the Skin
		1.1	 Introduction
		1.2	 Epidermis
			1.2.1	 Keratinocytes
			1.2.2	 Melanocytes
			1.2.3	 Langerhans Cells
			1.2.4	 Merkel Cells
		1.3	 Dermoepidermal Junction
		1.4	 Adnexa
			1.4.1	 Eccrine Sweat Units
			1.4.2	 Apocrine Units
			1.4.3	 Hair Follicles
			1.4.4	 Sebaceous Glands
			1.4.5	 Nails
		1.5	 Dermis
			1.5.1	 Vasculature
			1.5.2	 Muscles
			1.5.3	 Nerves
			1.5.4	 Mast Cells
		1.6	 Subcutaneous Tissue
		1.7	 Functions of the Skin
		References
	2: Wound Healing: Physiology and Pathology
		2.1	 Introduction
		2.2	 Types of Wound Healing
		2.3	 Phases of Wound Healing
			2.3.1	 Hemostasis
			2.3.2	 Inflammation
			2.3.3	 Proliferation
			2.3.4	 Remodeling
		2.4	 Factors Influencing Wound Healing
			2.4.1	 Systemic Factors
			2.4.2	 Local Factors
		2.5	 Pathological Wound Healing
			2.5.1	 Insufficient Scarring
			2.5.2	 Exuberant Scarring
				2.5.2.1	 Predisposing Factors to the Formation of Hypertrophic Scars
		2.6	 Scar Classification [13]
		2.7	 Exuberant Scar Treatment
		References
	3: Complicated Wounds
		3.1	 Introduction
		3.2	 Ulcers
			3.2.1	 Classification
			3.2.2	 Diagnosis
		3.3	 The Diabetic Foot Etiology
			3.3.1	 Diagnosis
			3.3.2	 Possible Complications of Complicated Wounds
			3.3.3	 Treatment of Complicated Wounds [8–14]
		3.4	 Osteomyelitis [15–22]
		References
	4: Suture Techniques
		4.1	 Introduction
		4.2	 General Principles
			4.2.1	 Handwashing and Patient Preparation
			4.2.2	 Surgical Instruments
			4.2.3	 Tissue Handling
			4.2.4	 Incision Placement and Planning
		4.3	 Closure Materials
			4.3.1	 Sutures
			4.3.2	 Needles
			4.3.3	 Alternative to Suturing
		4.4	 Basic Suture Techniques
			4.4.1	 Simple Interrupted Suture
			4.4.2	 Simple Running Suture
			4.4.3	 Vertical Mattress Suture
			4.4.4	 Horizontal Mattress Suture
			4.4.5	 Intradermal Suture
			4.4.6	 Deep Closure
		4.5	 Postoperative Dressing
		References
			Further Reading
	5: Dressings and Dermal Substitutes
		5.1	 Introduction
		5.2	 Standard Dressings
		5.3	 Hydrogel
		5.4	 Hydrocolloids and Hydrofibers
		5.5	 Sodium Alginate
			5.5.1	 Foams
		5.6	 Film Dressings
		5.7	 Advanced Dressings and Wound Types
			5.7.1	 Tie-Over Dressings
		5.8	 Dermal Substitutes
		References
	6: Grafts in Plastic Surgery
		6.1	 Introduction
		6.2	 Graft Classification
		6.3	 Physiology of Revascularization
			6.3.1	 Phase 1: Imbibition
			6.3.2	 Phase 2: Revascularization
			6.3.3	 Phase 3: Maturation
		6.4	 Complications in the Grafting Process
		6.5	 Skin Graft
			6.5.1	 Adnexa Grafts
		6.6	 Dermal Graft
		6.7	 Fat Graft
			6.7.1	 Bone Graft
		6.8	 Cartilage Graft
		6.9	 Vascular Graft
		6.10	 Nerve Graft
		6.11	 Fascial and Tendon Graft
		6.12	 Tissue Engineering
		References
			Further Reading
	7: History of Reconstructive Microsurgery: From Myth to Reality
		7.1	 Introduction
		7.2	 History on Free Flap Transfers in Japan
		7.3	 Introducing Perforator Flap and Fighting Against Traditional Microsurgery by the Authority
		7.4	 History on Nerve Flap
		7.5	 Surgery for Lymphedema
		7.6	 Nano-Microsurgery
		References
	8: Evolution of Soft Tissue Flaps Over Time
		8.1	 Introduction
		References
	9: Flaps in Plastic Surgery
		9.1	 Introduction
		9.2	 Definition
		9.3	 Classification of Flaps
		9.4	 Indication
		9.5	 Principle of Flap Surgery
			9.5.1	 The Reconstructive Elevator
			9.5.2	 The Guide for Reconstruction Using Flaps
		9.6	 Clinical Cases
		References
	10: Microsurgical Procedures in Plastic Surgery
		10.1	 Tools
			10.1.1	 Magnification System
			10.1.2	 Microsurgical Instruments
			10.1.3	 Sutures
		10.2	 Lifestyle and Ergonomics
		10.3	 Categories of Microsurgery
			10.3.1	 Microneural
			10.3.2	 Microvascular
		10.4	 Pictures of Microvascular Anastomosis
			10.4.1	 Microlymphatic
			10.4.2	 Microtubular Surgery
		10.5	 Replantation and Tissue Transplantation
		10.6	 Multidisciplinary Applications
			10.6.1	 Orthopedics
			10.6.2	 Neurosurgery
			10.6.3	 Head and Neck Surgery
			10.6.4	 Ophthalmology
			10.6.5	 General Surgery
			10.6.6	 Gynecology/Urology
		10.7	 Current and Future Perspectives
		References
	11: An Algorithm for Approaching Soft Tissue Coverage in the Twenty-First Century
		11.1	 Introduction
		References
Part ll: Plastic Surgery Approaches to Malformation
	12: Craniofacial Malformations
		12.1	 Introduction
		12.2	 Craniofacial Clefts
		12.3	 Cleft Lip and Palate
		12.4	 Craniosynostosis
		12.5	 Craniofacial Syndromes
			12.5.1	 Syndromic Craniosynostosis
			12.5.2	 Facial Syndromes
			12.5.3	 Craniofacial Microsomia
			12.5.4	 Frontonasal Malformations
		12.6	 Microtia
		12.7	 Micrognathia
		12.8	 Craniofacial Malformation Surgery
		12.9	 Cleft Lip and Palate Treatment
		12.10	 Surgical Management of Craniosynostosis
		12.11	 Management of Craniofacial Syndromes
		12.12	 Ear Reconstruction
		12.13	 Glossectomy for Macroglossia
		References
			Further Reading
	13: Malformations of the Hand
		13.1	 Introduction
		13.2	 Principles Governing Pediatric Management
			13.2.1	 Reconstruction of Congenital Differences of the Hand
				13.2.1.1	 Timing of Treatment
		13.3	 Epidemiology
		13.4	 Embryology of Limb Development
		13.5	 Classification
			13.5.1	 Failure of Formation of Parts: Transverse Arrest
				13.5.1.1	 Transverse Deficiencies
			13.5.2	 Proximal Transverse Deficiencies
			13.5.3	 Transverse Arrest of the Digits Distal to the Metacarpal Level
			13.5.4	 Failure of Formation of Parts: Longitudinal Arrest
				13.5.4.1	 Radial Longitudinal Deficiency
				13.5.4.2	 Ulnar Longitudinal Deficiency
				13.5.4.3	 Central Ray Deficiency
			13.5.5	 Undergrowth
				13.5.5.1	 Hypoplastic Thumb
			13.5.6	 Failure of Separation of Parts
				13.5.6.1	 Syndactyly
				13.5.6.2	 Radioulnar Synostosis
				13.5.6.3	 Symphalangism
				13.5.6.4	 Duplication (Polydactyly)
			13.5.7	 Overgrowth
				13.5.7.1	 Macrodactyly
			13.5.8	 Congenital Constriction Ring Syndrome
				13.5.8.1	 Constriction Rings
			13.5.9	 Flexion Deformities
				13.5.9.1	 Camptodactyly
				13.5.9.2	 Congenital Clasped Thumb
				13.5.9.3	 Arthrogryposis
			13.5.10 Pediatric Trigger Finger
		13.6	 Trigger Thumb
		13.7	 Trigger Finger
			13.7.1	 Physiotherapy
			13.7.2	 Psychological Aspects
		13.8	 Conclusions
		References
	14: Malformations of the External Genitalia
		14.1	 Introduction
		14.2	 Embryology
			14.2.1	 External Genitalia
			14.2.2	 Indifferent Stage
			14.2.3	 Different Stage
				14.2.3.1	 External Genitalia in Male
				14.2.3.2	 External Genitalia in the Female
		14.3	 Risk Factors
		14.4	 Main Malformations
			14.4.1	 Hypospadias
			14.4.2	 Etiology
		14.5	 Clinical Evaluation
		14.6	 Classification
		14.7	 Treatment
		14.8	 Sliding and Advancement
		14.9	 Mathieu Urethroplasty
		14.10	 Standoli Preputial Island Flap
		14.11	 Snodgrass One-Stage Repair
		14.12	 Braka Two-Stage Repair
		14.13	 Outcomes
		References
Part lll: Plastic Surgery for Trauma
	15: Wounds
		15.1	 Introduction
		15.2	 Mechanism, Etiology, and Classification
			15.2.1	 Bite, Sting, and Puncture Wounds
				15.2.1.1	 Mammalian Bites
				15.2.1.2	 Snakebites
				15.2.1.3	 Spider Bites
				15.2.1.4	 Bee and Wasp Stings
		15.3	 Clinical Evaluation
			15.3.1	 History
			15.3.2	 Wound Evaluation
			15.3.3	 Laboratory Studies
			15.3.4	 Imaging
			15.3.5	 Diagnostic Tests
		15.4	 Treatment
			15.4.1	 Wound Debridement and Preparation
			15.4.2	 Wound Closure
				15.4.2.1	 Secondary Intention
				15.4.2.2	 Primary Closure
				15.4.2.3	 Skin Grafting and Local Flaps
				15.4.2.4	 Free Tissue Transfer
			15.4.3	 Wound Dressing
		References
	16: Upper Limb Trauma
		16.1	 Generalities
			16.1.1	 Introduction
			16.1.2	 Essential Surgical Anatomy
			16.1.3	 Aetiology, Classification and Principles of Treatment
		16.2	 Upper Limb Trauma
			16.2.1	 Bone
			16.2.2	 Tendons
			16.2.3	 Nerves
			16.2.4	 Skin
			16.2.5	 Mangled Upper Limb and Amputations
		References
	17: Lower Limb Trauma
		17.1	 Introduction
		17.2	 History
		17.3	 Surgical Anatomy
			17.3.1	 Bones
			17.3.2	 Fascial Compartments and Lower Leg Muscles
			17.3.3	 Arteries
			17.3.4	 Nerves
		17.4	 Aetiology
		17.5	 Classification
		17.6	 Orthoplastic Concept and Lower Limb Trauma Score
		17.7	 Treatment
		17.8	 Clinical Cases (Figs. 17.8, 17.9, 17.10, and 17.11)
		Further Reading
	18: Burns: Classification and Treatment
		18.1	 Introduction
		18.2	 Etiology and Risk Factors
		18.3	 Skin Pathophysiology
		18.4	 Clinical Evaluation
		18.5	 Severe Burn Injury (SBI)
			18.5.1	 Resuscitation Phase
			18.5.2	 Hyperdynamic Hypermetabolic Phase
		18.6	 Acute Burn Trauma Management
		18.7	 Fluid Resuscitation
		18.8	 Hypermetabolic Phase Management
		18.9	 Management of the Burn Wound
		18.10	 Debridement
		18.11	 Wound Coverage
		18.12	 Burn Sequelae
		References
			Further Reading
	19: Extravasation
		19.1	 Introduction
			19.1.1	 Chemotherapy Extravasation
			19.1.2	 Extravasation Injury in Neonatal and Pediatric Patients
			19.1.3	 Chemotherapy Extravasation Injury Classification
			19.1.4	 Classification of Extravasation Injuries in Pediatric Patients [25–27]
		19.2	 Key Points
			19.2.1	 Extravasation Management
			19.2.2	 Technique of Saline Solution Infiltration [12–15]
				19.2.2.1	 Adults
				19.2.2.2	 Neonates and Infants
		References
	20: Radiodermatitis: Prevention and Treatment
		20.1	 Introduction
		20.2	 Clinical Presentation and Classification
		20.3	 Prevention and Treatment
		References
	21: Maxillofacial Surgery
		21.1	 Introduction
		21.2	 Emergency Management
			21.2.1	 Primary Diagnostic-Therapeutic Approach
				21.2.1.1	 Upper Airway Obstruction
				21.2.1.2	 Arrest of Bleeding
			21.2.2	 Secondary Diagnostic-Therapeutic Approach
			21.2.3	 Tertiary Diagnostic-Therapeutic Approach
		21.3	 Maxillofacial Fractures
		21.4	 Fractures of the Upper Third
			21.4.1	 Clinical Presentation
			21.4.2	 Surgical Treatment
			21.4.3	 Complications
		21.5	 Fractures of the Middle Third
			21.5.1	 Clinical Presentation
			21.5.2	 Surgical Treatment
			21.5.3	 Complications
		21.6	 Fractures of the Lower Third
			21.6.1	 Clinical Presentation
			21.6.2	 Surgical Treatment
				21.6.2.1	 Conservative Treatment
				21.6.2.2	 Surgical Treatment
			21.6.3	 Complications
		References
			Further Reading
Part lV: Plastic Surgery in Cancer Therapy
	22: Plastic Surgery for Skin Cancer
		22.1	 Introduction
		22.2	 Keratoacanthoma
		22.3	 Solitary Keratoacanthoma
		22.4	 Histopathology
		22.5	 Treatment
		22.6	 Basal Cell Carcinoma
			22.6.1	 Clinical Features
			22.6.2	 Natural History
			22.6.3	 Etiology and Pathogenesis
			22.6.4	 Histopathology
		22.7	 Differential Diagnosis
			22.7.1	 Treatment
		22.8	 Squamous Cell Carcinoma
			22.8.1	 Clinical Features
			22.8.2	 Histopathology
			22.8.3	 Differential Diagnosis
			22.8.4	 Treatment
		22.9	 Excisional Technique
		22.10	 Wound Healing, Flaps, and Grafts
			22.10.1	 Healing by Second Intention
			22.10.2	 Dermal Matrices
			22.10.3	 Flaps
				22.10.3.1	 Advancement Flap (Fig. 22.7)
				22.10.3.2	 Rotation Flap (Fig. 22.8)
				22.10.3.3	 Transposition Flaps (Fig. 22.9, Video 22.3)
			22.10.4	 Skin Grafts
				22.10.4.1	 Split-Thickness Skin Grafts
				22.10.4.2	 Full-Thickness Skin Grafts
				22.10.4.3	 Composite Grafts
		22.11	 Mohs Micrographic Surgery
		Bibliography
			Skin Cancer
			Skin Surgery
	23: Plastic Surgery in Melanoma Patients
		23.1	 Introduction
		23.2	 Etiology and Risk Factors
		23.3	 Clinical Evaluation
		23.4	 Histological Classification
		23.5	 Surgical Biopsy of a Suspicious Lesion
		23.6	 Prognostic Factors for Primary Lesion
		23.7	 Wide Local Excision
		23.8	 Sentinel Lymph Node Biopsy
		23.9	 Lymph Node Dissection
		23.10	 Melanoma Metastases
		23.11	 TNM Staging
		23.12	 Locoregional Treatment
		23.13	 Follow-Up
		References
	24: Sarcoma
		24.1	 Introduction and Background
		24.2	 Aetiology and Incidence
		24.3	 Soft Tissue Tumour Classification
			24.3.1	 Benign Lumps
			24.3.2	 Intermediate Lumps
			24.3.3	 Sarcomas
		24.4	 Diagnosing Sarcoma
		24.5	 Referral Pathway for Suspected Sarcoma
		24.6	 Staging and Grading Sarcoma
		24.7	 Management of Soft Tissue Sarcomas
		24.8	 Surgical Management
			24.8.1	 Example 1: Free Flaps
			24.8.2	 Example 2: Chimeric Free Flaps
		24.9	 Radiotherapy
		24.10	 Chemotherapy
		24.11	 Prognosis
		24.12	 Useful Reading
		References
Part V: Reconstructive Plastic Surgery
	25: Breast Reconstructive Surgery
		25.1	 General Considerations
		25.2	 Breast Reconstruction with Prosthetic Devices
			25.2.1	 Direct-to-Implant Reconstruction
			25.2.2	 Tissue Expander/Implant-Based Reconstruction
				25.2.2.1 Limitations
		25.3	 Breast Reconstruction with Autologous Tissue
			25.3.1	 Types of Autologous Reconstruction
			25.3.2	 Donor Sites
				25.3.2.1 LDM Flap
				25.3.2.2 TRAM Flap
				25.3.2.3 DIEAP Flap
				25.3.2.4 SIEA Flap
				25.3.2.5 SGAP Flap
				25.3.2.6 LAP Flap
				25.3.2.7 TDAP Flap
				25.3.2.8 Thigh Flaps
		25.4	 Secondary Refinements for the Reconstructed Breast
		References
	26: Abdominal Wall Surgery
		26.1	 Introduction
		26.2	 Surgical Anatomy
			26.2.1	 Anatomy of the Integument
			26.2.2	 Anatomy of the Myofascial System
			26.2.3	 Anatomy of Vessels, Nerves, and Lymphatics
		26.3	 Classification of the Abdominal Wall Defects
			26.3.1	 Congenital Defects
				26.3.1.1	 Omphalocele
				26.3.1.2	 Gastroschisis
				26.3.1.3	 Bladder Exstrophy
				26.3.1.4	 Umbilical Hernia
			26.3.2	 Acquired Defects
				26.3.2.1	 Partial Defects
					Diastasis Recti
					Hernia
					Postoperative or Incisional Hernia
				26.3.2.2	 Full-Thickness Defects
					Traumatic Defects
					Oncological Defects
		26.4	 Surgical Treatment
			26.4.1	 Repair of Congenital Defects
			26.4.2	 Repair of Acquired Defects
				26.4.2.1	 Repair of Partial Defects
					Diastasis Repair
					Hernia Repair
					Postoperative or Incisional Hernia Repair
				26.4.2.2	 Repair of Full-Thickness Defects
					Traumatic Defects Repair
					Oncological Defects Repair
		References
	27: Lymphedema: Diagnosis and Treatment
		27.1	 Introduction
		27.2	 Types of Lymphedema
		27.3	 Patient Assessment
		27.4	 Limb Circumference and Volume
		27.5	 Imaging
		27.6	 Management of Lymphedema
			27.6.1	 Conservative Management
			27.6.2	 Surgical Management
		27.7	 Results
		References
	28: Nerve Surgery
		28.1	 Introduction
		28.2	 Nerve Anatomy
		28.3	 Nerve Injury Classification
		28.4	 Nerve Regeneration
		28.5	 Nerve Reconstruction
			28.5.1	 Timing
			28.5.2	 General Principles
			28.5.3	 Techniques
			28.5.4	 Sutures
				28.5.4.1	 End-to-End Sutures
					Epineurial Suture
					Perineurial Suture
					Epiperineurial Combined Suture
				28.5.4.2	 End-to-Side Sutures
			28.5.5	 Nerve Grafts
				28.5.5.1	 Autograft
				28.5.5.2	 Allograft
				28.5.5.3	 Vascularized Nerve Grafts
			28.5.6	 Nerve Conduits
			28.5.7	 Nerve Transfer
				28.5.7.1	 Direct Neurotization
		28.6	 Other Techniques of Functional Restoration
			28.6.1	 Tendon Transfer
			28.6.2	 Functional Muscle Transfer
		28.7	 Facial Nerve Reconstruction
			28.7.1	 Treatment of Facial Nerve Injury
				28.7.1.1	 Facial Nerve Repair
				28.7.1.2	 Muscle Transfer for Reanimation
				28.7.1.3	 Static Reconstruction
		28.8	 Peripheral Nerve Reconstruction
			28.8.1	 Brachial Plexus and Upper Limb
			28.8.2	 Lower Limb
		28.9	 Assessment of Peripheral Nerve Function
		28.10	 Bionic Reconstruction and Future Perspectives
		References
			Further Reading
	29: Gender-Affirming Surgery
		29.1	 Terminology
		29.2	 Eligibility Criteria
		29.3	 Gender-Affirming Surgery in Transmasculine Individuals
			29.3.1	 Facial Masculinization
			29.3.2	 Gender-Affirming Mastectomy
			29.3.3	 Gender-Affirming Genital Surgery
				29.3.3.1	 Hysterectomy and Oophorectomy
				29.3.3.2	 Vaginectomy
				29.3.3.3	 Metoidioplasty
				29.3.3.4	 Phalloplasty
				29.3.3.5	 Additional Procedures
		29.4	 Gender-Affirming Surgery in Transfeminine Individuals
			29.4.1	 Facial Feminization
			29.4.2	 Gender-Affirming Augmentation Mammoplasty
			29.4.3	 Gender-Affirming Genital Surgery
				29.4.3.1	 Penile Inversion Vaginoplasty
				29.4.3.2	 Intestinal Vaginoplasty
				29.4.3.3	 Other Less Common Techniques
		References
			Further Reading
	30: Regenerative Surgery
		30.1	 Introduction
			30.1.1	 History and Development of Regenerative Surgery
			30.1.2	 Principles and Techniques of Regenerative Surgery
				30.1.2.1	 Fat Grafting, the Vascular-Stromal Fraction, and ADSCs
				30.1.2.2	 Cell-Assisted Lipotransfer (CAL)
				30.1.2.3	 PRP and Platelet-Rich Lipotransfer (PRL)
				30.1.2.4	 Scaffolds and Tissue Engineering
			30.1.3	 Clinical Applications in Regenerative Surgery
				30.1.3.1	 Breast Surgery
				30.1.3.2	 Wound Healing and Scar Treatment
				30.1.3.3	 Facial Aesthetic and Reconstructive Surgery
				30.1.3.4	 Regulatory Issues
				30.1.3.5	 Future Perspectives
		References
	31: Advanced Reconstructive Plastic Surgery
		31.1	 Introduction
		31.2	 Perforator Flaps
			31.2.1	 Breast Reconstruction
			31.2.2	 Head and Neck Reconstruction
			31.2.3	 Perineum Reconstruction
			31.2.4	 Lower Extremity Reconstruction
			31.2.5	 Trunk Reconstruction
			31.2.6	 Freestyle Perforator Flaps
			31.2.7	 Supermicrosurgery
			31.2.8	 Combined Flaps (Conjoined Flaps, Composite Flaps, Chimeric Flaps)
				31.2.8.1	 Conjoined Flaps
				31.2.8.2	 Combined Flaps
				31.2.8.3	 Chimeric Flaps
			31.2.9	 Endoscopic Approaches
		31.3	 Diversion Loop for Reconstruction of Upper Esophagus in the Case of Epiglottis Injury
		31.4	 Voice Reconstruction with Intestinal Flaps
		31.5	 Lymphedema Treatment
		31.6	 Lymphatic Cable Flap for Chyloperitoneum
		31.7	 Composite Tissue Transplantation
		References
	32: Transplant and Plastic Surgery
		32.1	 Introduction
		32.2	 Hand Transplant
		32.3	 Face Transplant
		32.4	 Penile Transplant
		32.5	 Uterine Transplant
		32.6	 Abdominal Wall Transplant
		32.7	 Laryngeal Transplant
		32.8	 Unique Aspects of VCA
			32.8.1	 Ethical Concerns
			32.8.2	 Recipient Screening
		32.9	 Donor Selection
		32.10	 Nerve Regeneration
		32.11	 Virtual Surgical Planning and 3D-Printed Guides
		32.12	 Immunosuppression
		References
Part VI: Aesthetic Plastic Surgery
	33: Aesthetic Plastic Surgery
		33.1	 Mammary Gland
			33.1.1	 Augmentation Mammoplasty
			33.1.2	 Breast Reduction
			33.1.3	 Mastopexy (Breast Lift)
			33.1.4	 Gynecomastia Correction
		33.2	 Rhinoplasty
		33.3	 Liposuction
		33.4	 Abdominoplasty
		33.5	 Thighplasty
		33.6	 Brachioplasty
		33.7	 Gluteoplasty (Buttock Lift)
		33.8	 Facelift
		33.9	 Face Lipofilling
		33.10	 Blepharoplasty
		33.11	 Otoplasty
		Bibliography
	34: Plastic Surgery in the COVID-19 Era
		34.1	 Introduction
		34.2	 The Response of Plastic Surgery Services
		34.3	 Learning and Sharing Knowledge While Facing the COVID-19 Pandemic
		References
Index