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Surgical management of the burn wound
592
BRITISH JOURNAL OF PLASTIC SURGERY
Surgical Management of the Burn Wound. By David M. Heimbach and Loren H. Engraw. Pp. 176 with colour photographic illustrations. (New York: Raven Press, 1984.) Price $93.50. The pr&cis to this book states that its primary intent is “to aid general and plastic surgeons with general wound management of burns of all sizes according to the area of the body involved.” The authors have certainly succeeded in this task, and acknowledge the part played by anaesthetist and nursing staff in their regime-including an excellent contribution from each. With few reservations a plea is made for early surgery in any burn which is considered unlikely to heal in three weeks whatever its extent. The first three chapters consider general factorspatient selection, excisionai techniques, wound closure. Individual areas of the body are then discussed separately in greater detail. It soon becomes evident that this book is not written from an armchair, but by practising and practical surgeons who themselves have met problems in looking after burn patients and try to present at least some of their solutions to others. The lavish use of superb colour clinical photographs illustrates, emphasises and elaborates the points made in the text. A great deal of practical detail is included, the photographs showing the application of techniques in individual patients. Each chapter ends with a list of maxims summarising and emphasising important aspects of the section and these are all of great practical value. Being American in origin some of the materials and instruments suggested are not available in Europe. This is particularly the case with Biobrane which is used extensively as a skin substitute. Some of the techniques suggested might be considered less acceptable, e.g., the use of skeletal traction and the elaborate splinting used for the grafted hand. Also although the authors recognise the superiority in many instances of sheet grafting, mesh grafting appears to be used extensiveiy. Many would criticise its use in smaller injuries. This book is for the specialist in bum care. The surgical and nursing technioues involved cannot be learned from a book, good a< this one is. It should, however, be readily available to all concerned in the surgical care of the burn patient. ANNE 3. SUTHERLAND
Guillaume Dupuytren: a surgeon in his place and time. By Hannah K. Barsky. Pp. xii -i-29.5 with 24 illustrations. First Edition. (New York: Vantage Press Inc. 1984.) Price US $14.95. Most of us, I suspect, have compiled a highly personal and emotively unscientific list of “hero figures”, some of them contemporary, others long since dead, who have in some way influenced our study, understanding and practice of surgery. Dupuytren’s name has always been near the top of my list, so that I opened this book with high expectations of enjoyment and educational enrichment. It looked good, it was a convenient size, nicely printed, it appeared to have been carefully researched over several years and although Mrs Hannah Barsky herself is not a doctor, her late husband, Dr Arthur J. Barsky, was a distinguished American plastic surgeon whom I had met on several occasions and whose book on Plastic Surgery was in the 1950’s the best book available for the trainee in plastic sur-
gery along with David Matthew’s smaller book “The Surgery of Repair”. Mrs Barsky had obviously taken great pains to collect background information so that she could, as explained in the words of the publishers of the book jacket, “. . paint a fascinating picture of his time and the people he knew-the people who shaped the arts. the sciences and even the governments of the day”. In a burst of hyperbole, the publishers added that “. each of these people and events is wonderfully related to the character and development of the grand master himself in skillful blend of fact, speculation and anecdote”. But as I began to read the book I soon became increasingly troubled and irritated for my reaction to the book bore no resemblance to that of the publishers’ blurb on the book jacket. Little new has been added to what we already know of Dupuytren’s childhood, early general and medical education, surgical career and the medico-political infighting of the day. In the chapters devoted specifically to Dupuytren’s work and life, the content, stripped of its padding, is thin and the style of writing not particularly inspiring. The remaining chapters that deal with the cultural, scientific, and political background are as incomplete and disjointed as the background notes that we find in the programmes distributed at orchestral concerts. Names are dropped like confetti (for no obvious reason), “purple passages” of prose fill page after page, speculation and anecdotal tales run riot. Nowhere are we given any deep insight as to whether this background influenced Dupuytren or not or any inkling of his personal views on the social upheaval that was taking place at the time. In my view, the authoress set herself an extremely difficult task. A writer, just like a painter or a musician, cannot always pull off a masterpiece or even a good piece of writing. In the same way, a surgeon does not always perform superlatively well. This is not a happy book: I would certainly not buy a copy or even give one to a friend. But Dupuytren has not lost his place in my list of surgical heroes. MICHAEL
N. TEMPEST
Wound Healing for Surgeons. Timothy E. Bucknall and Harold Ellis. Pp. 344. (Bailliere Tindall, 1984.) Price E19.75. This book gives a general outline on a broad canvas with some areas of considerable detail reflecting the special interest of the authors of those chapters. The twenty authors are either authorities in their field or diligent bibliographers. Only one is not a surgeon and only one works out of the United Kingdom and thus the book is intelligible to surgeons and readable. Grammar, vocabufary and style are British and attractive except for one chapter which has more personal pronouns than one would ever expect in a textbook. The special value of the book is that the healing of tissues and organs are considered separately to include skin, gut, nerves, vessels, serosae, bones, tendons, liver, bile ducts, pancreas and spleen. The book is suitable for the surgeon who is preparing for examinations, or who has left that phase of learning behind and now wishes to know what has happened in wound healing in the past twenty years, without recourse to the literature. It serves this function well. The diagrams are clear but sometimes are labelled with irritating ciphers requiring translation below. The photographs are monochrome and generally good.
BRITISH JOURNAL OF PLASTIC SURGERY
Surgical Management of the Burn Wound. By David M. Heimbach and Loren H. Engraw. Pp. 176 with colour photographic illustrations. (New York: Raven Press, 1984.) Price $93.50. The pr&cis to this book states that its primary intent is “to aid general and plastic surgeons with general wound management of burns of all sizes according to the area of the body involved.” The authors have certainly succeeded in this task, and acknowledge the part played by anaesthetist and nursing staff in their regime-including an excellent contribution from each. With few reservations a plea is made for early surgery in any burn which is considered unlikely to heal in three weeks whatever its extent. The first three chapters consider general factorspatient selection, excisionai techniques, wound closure. Individual areas of the body are then discussed separately in greater detail. It soon becomes evident that this book is not written from an armchair, but by practising and practical surgeons who themselves have met problems in looking after burn patients and try to present at least some of their solutions to others. The lavish use of superb colour clinical photographs illustrates, emphasises and elaborates the points made in the text. A great deal of practical detail is included, the photographs showing the application of techniques in individual patients. Each chapter ends with a list of maxims summarising and emphasising important aspects of the section and these are all of great practical value. Being American in origin some of the materials and instruments suggested are not available in Europe. This is particularly the case with Biobrane which is used extensively as a skin substitute. Some of the techniques suggested might be considered less acceptable, e.g., the use of skeletal traction and the elaborate splinting used for the grafted hand. Also although the authors recognise the superiority in many instances of sheet grafting, mesh grafting appears to be used extensiveiy. Many would criticise its use in smaller injuries. This book is for the specialist in bum care. The surgical and nursing technioues involved cannot be learned from a book, good a< this one is. It should, however, be readily available to all concerned in the surgical care of the burn patient. ANNE 3. SUTHERLAND
Guillaume Dupuytren: a surgeon in his place and time. By Hannah K. Barsky. Pp. xii -i-29.5 with 24 illustrations. First Edition. (New York: Vantage Press Inc. 1984.) Price US $14.95. Most of us, I suspect, have compiled a highly personal and emotively unscientific list of “hero figures”, some of them contemporary, others long since dead, who have in some way influenced our study, understanding and practice of surgery. Dupuytren’s name has always been near the top of my list, so that I opened this book with high expectations of enjoyment and educational enrichment. It looked good, it was a convenient size, nicely printed, it appeared to have been carefully researched over several years and although Mrs Hannah Barsky herself is not a doctor, her late husband, Dr Arthur J. Barsky, was a distinguished American plastic surgeon whom I had met on several occasions and whose book on Plastic Surgery was in the 1950’s the best book available for the trainee in plastic sur-
gery along with David Matthew’s smaller book “The Surgery of Repair”. Mrs Barsky had obviously taken great pains to collect background information so that she could, as explained in the words of the publishers of the book jacket, “. . paint a fascinating picture of his time and the people he knew-the people who shaped the arts. the sciences and even the governments of the day”. In a burst of hyperbole, the publishers added that “. each of these people and events is wonderfully related to the character and development of the grand master himself in skillful blend of fact, speculation and anecdote”. But as I began to read the book I soon became increasingly troubled and irritated for my reaction to the book bore no resemblance to that of the publishers’ blurb on the book jacket. Little new has been added to what we already know of Dupuytren’s childhood, early general and medical education, surgical career and the medico-political infighting of the day. In the chapters devoted specifically to Dupuytren’s work and life, the content, stripped of its padding, is thin and the style of writing not particularly inspiring. The remaining chapters that deal with the cultural, scientific, and political background are as incomplete and disjointed as the background notes that we find in the programmes distributed at orchestral concerts. Names are dropped like confetti (for no obvious reason), “purple passages” of prose fill page after page, speculation and anecdotal tales run riot. Nowhere are we given any deep insight as to whether this background influenced Dupuytren or not or any inkling of his personal views on the social upheaval that was taking place at the time. In my view, the authoress set herself an extremely difficult task. A writer, just like a painter or a musician, cannot always pull off a masterpiece or even a good piece of writing. In the same way, a surgeon does not always perform superlatively well. This is not a happy book: I would certainly not buy a copy or even give one to a friend. But Dupuytren has not lost his place in my list of surgical heroes. MICHAEL
N. TEMPEST
Wound Healing for Surgeons. Timothy E. Bucknall and Harold Ellis. Pp. 344. (Bailliere Tindall, 1984.) Price E19.75. This book gives a general outline on a broad canvas with some areas of considerable detail reflecting the special interest of the authors of those chapters. The twenty authors are either authorities in their field or diligent bibliographers. Only one is not a surgeon and only one works out of the United Kingdom and thus the book is intelligible to surgeons and readable. Grammar, vocabufary and style are British and attractive except for one chapter which has more personal pronouns than one would ever expect in a textbook. The special value of the book is that the healing of tissues and organs are considered separately to include skin, gut, nerves, vessels, serosae, bones, tendons, liver, bile ducts, pancreas and spleen. The book is suitable for the surgeon who is preparing for examinations, or who has left that phase of learning behind and now wishes to know what has happened in wound healing in the past twenty years, without recourse to the literature. It serves this function well. The diagrams are clear but sometimes are labelled with irritating ciphers requiring translation below. The photographs are monochrome and generally good.