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The World of Surgery, 1945–1985. Memoirs of one participant
Late Sequelae Frcrn Facial Bcne Fractures
Subperiosteal dissection has been shown to be safe. For practical purposes we can denude the face of its soft tissues for access to the underlying skeleton without injury to the overlying soft tissue, especially, the facial nerve. Segmental osteotomy to reposition displaced bones that have healed unreduced is a technique to be considered in patients with severe posttraumatic deformities. Primary bone grafting during the initial repair and bone grafting during secondary reconstruction are now commonplace in our experience. We have all been reluctant to use bone grafts in the past because it meant either rib grafts or iliac grafts, both of which have been very uncomfortable to the patient and involve going to different areas of the body. Recently, the availability of calvarial bone grafts has given us enthusiasm for bone grafting because it is in the immediate area, and the morbidity associated with calvarial bone grafts is minimal. We believe the results with the use of bone grafts have shown reduced long-term cosmetic deformities.. The miniplates allow rigid internal fixation which mini-
mize the secondary complications that were due to inadequate fixation. Regarding your comments, Dr. Furnas, it remains a problem to decide how much volume to attempt to add to the orbit in the form of bone grafts to correct an enophthalmos. Like many other surgical problems, reasonable overcorrection is appropriate. It remains to the judgment of the surgeon. The real source of anxiety in trying to correct an enophthalmos still continues to be fear of damage to the optic nerve. However, we have become more courageous in this regard than we have been in the past 10 or 15 years. When should one not use calvarial bone grafts? The implication of the question, I presume, means when should the surgeon use alloplastic materials. I guess everything new always works, and we are still enthusiastic enough about calvarial bone grafts that except for large cranial defects where the neurosurgeons have shown methyl methacrylate to be an excellent material, we still prefer to use bone grafts in the restoration of the facial features, particularly around the nose and orbit.
Book Reviews (cont’d) provides an excellent review. In addition, the role of injection sclerotherapy in bleeding esophageal varices is well presented and the methods clearly outlined. Unfortunately, other topics are not well presented. Although useful in a surgical library, I believe that the price is too high to justify individual purchase.
with Dr. Hardy’s efforts to develop a significant academic and clinical presence in a new school in an era in which there was considerable political and racial turmoil influencing virtually his every activity. Notwithstanding these points, the most significant themes in the book are of interest to young academic surgeons. One theme is the difficulty of establishing a viable new medical school in an environment in which the physicians in the founding region choose to oppose it directly, indirectly, and often overtly. Another theme is the ease with which promises of support are made by sundry university officials and the difficulty with which such promises are kept by a few upright and thoroughly ethical university leaders. A third theme is a recurrent one and that is the petty and destructive nature of interspecialty rivalries within and among the surgical disciplines. If there is one lesson that can be learned from the turmoil of the last 20 years, it is that academic surgical unite have more in common than they ever had differences and that the surest way to provide fuel for one’s enemies within and without and above and below is pointless and petty haggling over administrative structure and selfishly precious autonomy. There are parts of the book that move slowly, and it may not strike the same chord in some readers as it did in me. On the other hand, it is my summary opinion that the threads of thought and the lessons for the young academic surgeon make this book well worth reading in depth and detail. Such a reader should contemplate its significance to his or her own career.
E. R. Woodward,MD Gainesville, Florida
The World of Surgery, 1945-1985. Memoirs Participant. By James D. Hardy. Philadelphia: sity of Pennsylvania Press, 1986.371 pages.
of One Univer-
This is a broadly interesting and self-effacing look at the world of surgery in the last 40 years by a person who was more than a participant. Dr. Hardy was an informed, compassionate, and thoughtful leader of that world. I have more than a passing interest in the volume in no small part because the author served as my family’s personal physician for much of the last decade and he has accomplished the most significant portion of his professional career in the town of my birth. I make much of this because Dr. Hardy’s energy, efforts, and many aspects of his career were influenced by the rather remarkably strident segregationist tactics of the state in which he chose to live. Dr. Hardy, as others from similar states, was tarred and feathered with the brush that if one lives in a given place he must, by definition, hold to those same principles. Some of the most poignant portions of this book deal
Vohme154,July1997
Hiram C. Polk, Jr. Edltor
153
Subperiosteal dissection has been shown to be safe. For practical purposes we can denude the face of its soft tissues for access to the underlying skeleton without injury to the overlying soft tissue, especially, the facial nerve. Segmental osteotomy to reposition displaced bones that have healed unreduced is a technique to be considered in patients with severe posttraumatic deformities. Primary bone grafting during the initial repair and bone grafting during secondary reconstruction are now commonplace in our experience. We have all been reluctant to use bone grafts in the past because it meant either rib grafts or iliac grafts, both of which have been very uncomfortable to the patient and involve going to different areas of the body. Recently, the availability of calvarial bone grafts has given us enthusiasm for bone grafting because it is in the immediate area, and the morbidity associated with calvarial bone grafts is minimal. We believe the results with the use of bone grafts have shown reduced long-term cosmetic deformities.. The miniplates allow rigid internal fixation which mini-
mize the secondary complications that were due to inadequate fixation. Regarding your comments, Dr. Furnas, it remains a problem to decide how much volume to attempt to add to the orbit in the form of bone grafts to correct an enophthalmos. Like many other surgical problems, reasonable overcorrection is appropriate. It remains to the judgment of the surgeon. The real source of anxiety in trying to correct an enophthalmos still continues to be fear of damage to the optic nerve. However, we have become more courageous in this regard than we have been in the past 10 or 15 years. When should one not use calvarial bone grafts? The implication of the question, I presume, means when should the surgeon use alloplastic materials. I guess everything new always works, and we are still enthusiastic enough about calvarial bone grafts that except for large cranial defects where the neurosurgeons have shown methyl methacrylate to be an excellent material, we still prefer to use bone grafts in the restoration of the facial features, particularly around the nose and orbit.
Book Reviews (cont’d) provides an excellent review. In addition, the role of injection sclerotherapy in bleeding esophageal varices is well presented and the methods clearly outlined. Unfortunately, other topics are not well presented. Although useful in a surgical library, I believe that the price is too high to justify individual purchase.
with Dr. Hardy’s efforts to develop a significant academic and clinical presence in a new school in an era in which there was considerable political and racial turmoil influencing virtually his every activity. Notwithstanding these points, the most significant themes in the book are of interest to young academic surgeons. One theme is the difficulty of establishing a viable new medical school in an environment in which the physicians in the founding region choose to oppose it directly, indirectly, and often overtly. Another theme is the ease with which promises of support are made by sundry university officials and the difficulty with which such promises are kept by a few upright and thoroughly ethical university leaders. A third theme is a recurrent one and that is the petty and destructive nature of interspecialty rivalries within and among the surgical disciplines. If there is one lesson that can be learned from the turmoil of the last 20 years, it is that academic surgical unite have more in common than they ever had differences and that the surest way to provide fuel for one’s enemies within and without and above and below is pointless and petty haggling over administrative structure and selfishly precious autonomy. There are parts of the book that move slowly, and it may not strike the same chord in some readers as it did in me. On the other hand, it is my summary opinion that the threads of thought and the lessons for the young academic surgeon make this book well worth reading in depth and detail. Such a reader should contemplate its significance to his or her own career.
E. R. Woodward,MD Gainesville, Florida
The World of Surgery, 1945-1985. Memoirs Participant. By James D. Hardy. Philadelphia: sity of Pennsylvania Press, 1986.371 pages.
of One Univer-
This is a broadly interesting and self-effacing look at the world of surgery in the last 40 years by a person who was more than a participant. Dr. Hardy was an informed, compassionate, and thoughtful leader of that world. I have more than a passing interest in the volume in no small part because the author served as my family’s personal physician for much of the last decade and he has accomplished the most significant portion of his professional career in the town of my birth. I make much of this because Dr. Hardy’s energy, efforts, and many aspects of his career were influenced by the rather remarkably strident segregationist tactics of the state in which he chose to live. Dr. Hardy, as others from similar states, was tarred and feathered with the brush that if one lives in a given place he must, by definition, hold to those same principles. Some of the most poignant portions of this book deal
Vohme154,July1997
Hiram C. Polk, Jr. Edltor
153