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Microsurgery: A practical guide for surgeons
British Journul o~Plnsfir Surgery (1981) 34, 114-l 16 C‘ 1981 The Trustees of British Association of Plastic Surgeons
BOOK
REVIEWS
Fundamental Techniques of Plastic Surgery and Their Surgical Applications. By Ian A. McGregor, MB, ChM, FRCS. Seventh Ed. Pp. x+336, with 218 illustrations. (Edinburgh: Churchill Livingstone). Price &8.00. This is the seventh edition of a standard the pocket guide for catechumen plastic
text which has been surgeons throughout
the last 20 years. There can be few who have essayed or trained in reconstructive surgery during this time who have not been grateful to previous editions of this book for supplementing their training in the principles and operative techniques. Its clarity of script, layout, print and diagrams is exemplary, and a sound knowledge of its contents should be required of all Final Fellowship candidates. This edition includes many new illustrations, but modern printing techniques have not done justice to Alan McIlroy’s photographs. Alterations include the relegation of the random pattern tubed flap to near “dinosaur” status. There are now descriptions of many of the new important flaps in two chapters, one on skin flaps and the other on muscle and myocutaneous flaps. Other compound and omental flaps are excluded. Free flaps are mentioned, but details of technique of these and replantations would have been out of place in this basic book. An understanding of the natural history of scars is a prerequisite of successful surgery and a welcome change in future editions would be a more succinct account of this and modern management of scar hypertrophy. JOHN
LENDRUM
Microsurgery: A Practical Guide for Surgeons. Edited by Sherman J. Silber, MD. (Baltimore: Williams and Wilkins, 1979). Price f33.80. does it standing up. Dr Silber, like a windsurfer. Unfortunately, he tries to make a virtue out of this often unavoidable necessity for surgeons working inside the abdomen. Rollin Daniel in the foreword (there is a complicated prologue of preface, foreword and introduction) states sycophantically that reconstructive surgeons should not become involved in genital surgery and certainly this book is not intended for plastic surgeons. It is too long. The 43 pages devoted to free tissue transfer could have been omitted, a good deal of repetition about microsurgical technique usefully pruned and most of the unhelpful and largely irrelevant illustrations left out, particularly the four pages of colour prints that serve as a frontispiece, which must have added significantly to the cost. Despite these criticisms this book is likely to be regarded as the reference book to which people turn when confronted by microsurgery. In this field it is clearly reproductive outstanding. MARTYN H. C. WEBSTER
book. Here they can be consulted by the examination candidate if need be. Most ophthalmologists, many with reluctance, have to diagnose and treat this condition which may tax their competence to the utmost. This book is lucidly written and the author after a chapter on the evolution of ptosis plunges into its practical management. Great stress is rightly placed on the degree of levator action in deciding what to do, rather than on the degree of ptosis or the kind of ptosis. Clear guidelines are laid down depending on the degree of levator action measured in mm. “Special cases” such as neurogenic. myogenic ptosis as well as complicated ptosis are considered in more detail in chapter 10. It is interesting that local anaesthesia is suggested as the first choice in all adults where possible with the main advantage being that of having the patient’s co-operation in making final adjustments to align the eyelid. Most British for long used to a uniformly high standard of surgeons, general anaesthesia. would disagree with this tenet. The advantages of hypotension and hyperventilation in providing an almost bloodless field are considered to be of more importance than the patient’s co-operation in looking upwards in what must in any case be a rather hit and miss adjustment in an oedematous tissue. There follow detailed instructions and many useful tips on levator resection by anterior and posterior approaches with the comments of experience of each. It is surprising to find no mention of the combined anterior approach of Putterman & Urist (Amer. J. Oph. Jan., 1974) which although it has a few disadvantages does make the dissection easier. In unilateral ptosis where there is no levator action and a frontalis sling is the treatment of choice, the lid lag on downward gaze may be a problem. The author, while mentioning a bilateral sling after eliminating the contralateral levator action is, I am glad to see, very lukewarm about seriously advocating this course of Beard who considers it mandatory. The instructive chapters on surgery end with one on complications which we all suffer in varying degrees. These are concisely and sensibly handled. All in all this is a first class book and probably the most useful monograph on ptosis currently available. MALCOLM
V. GRAHAM
Following Mastectomy. By Breast Reconstruction Nicholas G. Georgiade. Pp. xiv+267, with 139 illustrations. (St. Louis: The C. V. Mosby Company, 1979). Price f27. This book is a valuable contribution to the rapidly developing art (or science) of breast reconstruction following mastectomy. It is written primarily by Professor Georgiade with contributions by several of his colleagues from Duke University. It follows and complements their recent “Reconstructive Breast Surgery”. For the plastic surgeon with some experience in methods of breast reconstruction, the most valuable parts of the book are probably those not dealing with surgical technique. These provide a useful refresher and updating *‘course” for those some distance away from their general surgical experience. of the psychological effects of There are accounts
Surgery of Ptosis. By Sidney A. Fox. First Edition. Pp. ix+ 165, with 125 illustrations. (Baltimore: Waverly Press, Inc., 1979). Price unknown. It is refreshing to find the obligatory chapters on anatomy, physiology and pathology relegated to the end of this small 114
BOOK
REVIEWS
Fundamental Techniques of Plastic Surgery and Their Surgical Applications. By Ian A. McGregor, MB, ChM, FRCS. Seventh Ed. Pp. x+336, with 218 illustrations. (Edinburgh: Churchill Livingstone). Price &8.00. This is the seventh edition of a standard the pocket guide for catechumen plastic
text which has been surgeons throughout
the last 20 years. There can be few who have essayed or trained in reconstructive surgery during this time who have not been grateful to previous editions of this book for supplementing their training in the principles and operative techniques. Its clarity of script, layout, print and diagrams is exemplary, and a sound knowledge of its contents should be required of all Final Fellowship candidates. This edition includes many new illustrations, but modern printing techniques have not done justice to Alan McIlroy’s photographs. Alterations include the relegation of the random pattern tubed flap to near “dinosaur” status. There are now descriptions of many of the new important flaps in two chapters, one on skin flaps and the other on muscle and myocutaneous flaps. Other compound and omental flaps are excluded. Free flaps are mentioned, but details of technique of these and replantations would have been out of place in this basic book. An understanding of the natural history of scars is a prerequisite of successful surgery and a welcome change in future editions would be a more succinct account of this and modern management of scar hypertrophy. JOHN
LENDRUM
Microsurgery: A Practical Guide for Surgeons. Edited by Sherman J. Silber, MD. (Baltimore: Williams and Wilkins, 1979). Price f33.80. does it standing up. Dr Silber, like a windsurfer. Unfortunately, he tries to make a virtue out of this often unavoidable necessity for surgeons working inside the abdomen. Rollin Daniel in the foreword (there is a complicated prologue of preface, foreword and introduction) states sycophantically that reconstructive surgeons should not become involved in genital surgery and certainly this book is not intended for plastic surgeons. It is too long. The 43 pages devoted to free tissue transfer could have been omitted, a good deal of repetition about microsurgical technique usefully pruned and most of the unhelpful and largely irrelevant illustrations left out, particularly the four pages of colour prints that serve as a frontispiece, which must have added significantly to the cost. Despite these criticisms this book is likely to be regarded as the reference book to which people turn when confronted by microsurgery. In this field it is clearly reproductive outstanding. MARTYN H. C. WEBSTER
book. Here they can be consulted by the examination candidate if need be. Most ophthalmologists, many with reluctance, have to diagnose and treat this condition which may tax their competence to the utmost. This book is lucidly written and the author after a chapter on the evolution of ptosis plunges into its practical management. Great stress is rightly placed on the degree of levator action in deciding what to do, rather than on the degree of ptosis or the kind of ptosis. Clear guidelines are laid down depending on the degree of levator action measured in mm. “Special cases” such as neurogenic. myogenic ptosis as well as complicated ptosis are considered in more detail in chapter 10. It is interesting that local anaesthesia is suggested as the first choice in all adults where possible with the main advantage being that of having the patient’s co-operation in making final adjustments to align the eyelid. Most British for long used to a uniformly high standard of surgeons, general anaesthesia. would disagree with this tenet. The advantages of hypotension and hyperventilation in providing an almost bloodless field are considered to be of more importance than the patient’s co-operation in looking upwards in what must in any case be a rather hit and miss adjustment in an oedematous tissue. There follow detailed instructions and many useful tips on levator resection by anterior and posterior approaches with the comments of experience of each. It is surprising to find no mention of the combined anterior approach of Putterman & Urist (Amer. J. Oph. Jan., 1974) which although it has a few disadvantages does make the dissection easier. In unilateral ptosis where there is no levator action and a frontalis sling is the treatment of choice, the lid lag on downward gaze may be a problem. The author, while mentioning a bilateral sling after eliminating the contralateral levator action is, I am glad to see, very lukewarm about seriously advocating this course of Beard who considers it mandatory. The instructive chapters on surgery end with one on complications which we all suffer in varying degrees. These are concisely and sensibly handled. All in all this is a first class book and probably the most useful monograph on ptosis currently available. MALCOLM
V. GRAHAM
Following Mastectomy. By Breast Reconstruction Nicholas G. Georgiade. Pp. xiv+267, with 139 illustrations. (St. Louis: The C. V. Mosby Company, 1979). Price f27. This book is a valuable contribution to the rapidly developing art (or science) of breast reconstruction following mastectomy. It is written primarily by Professor Georgiade with contributions by several of his colleagues from Duke University. It follows and complements their recent “Reconstructive Breast Surgery”. For the plastic surgeon with some experience in methods of breast reconstruction, the most valuable parts of the book are probably those not dealing with surgical technique. These provide a useful refresher and updating *‘course” for those some distance away from their general surgical experience. of the psychological effects of There are accounts
Surgery of Ptosis. By Sidney A. Fox. First Edition. Pp. ix+ 165, with 125 illustrations. (Baltimore: Waverly Press, Inc., 1979). Price unknown. It is refreshing to find the obligatory chapters on anatomy, physiology and pathology relegated to the end of this small 114