Foreword

It is significant that the first medical description of the clinical and genetic features of haemophilia was by the "father of surgery'' Abu al-Qasim Khalaf bin 'Abbas el-Zahrawi (940P-1031 C.E.), so called for his extensive original descriptions of operative techniques and instrumentation. Characteristically he also described a method for stopping bleeding in haemophilia by local pressure and cauterisation, which he had witnessed.

Surgeons have always been concerned with bleeding and haemostasis since the first obvious side effect of any surgical intervention is blood loss. Means to control and limit bleeding during and after surgery remain a topic central to modern practice of the speciality, in which larger operative fields need to be kept ''dry'' or in which very small areas under the operating microscope need to be clearly seen without obscuring blood. Hence it may be surprising that, prior to the present volume, no other work has been published exclusively devoted to this topic.

Our present understanding of the highly complex physiological system that has evolved to keep blood fluid within the circulation and yet allow for it to rapidly form a leak proof plug at the site of any injury is now fairly mature. Yet there remain circumstances in which bleeding continues in spite of adequate amounts of platelets and of all the known coagulation proteins. New reagents, such as recombinant factor Vila, are now under trial that may offer help to the hard pressed surgeon dealing with massive trauma of difficult re-operations where such bleeding occurs. Thus, although our knowledge of all the details of haemostasis in situ may still be incomplete, practical help is at hand as described within these pages.

Hakim and Canelo have marshalled a team of experts to consider this vital topic in each of the major areas of surgical practice, and have thus brought together a vast body of experience and analysis to address the ever-present threat of incontrolled blood loss or its obverse unwanted thrombosis during and after surgery.

i recommend this volume to all who have to deal with surgical bleeding both as a general educational reference and as a source of specific advice in the multitude of situations where bleeding or thrombosis may be encountered in surgical practice.

Edward G. D. Tuddenham

Professor of Haemostasis Imperical College London, UK

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