Last's Anatomy: Regional and Applied, 11th Edn

Abstract

Last's Anatomy: Regional and Applied has long been a favourite with senior medical students and junior doctors studying for the MRCS examination. Most anatomy textbooks take the form of either large reference tomes or short books aimed at rapid pre-examination cramming. In contrast, Last's Anatomy is both comprehensive enough to satisfy postgraduate surgical expectations, and sufficiently focused to make it a realistic exam revision tool. Since its first appearance in 1954, Last's Anatomy has benefited from a relatively low turnover of single editors, all fellows of The Royal College of Surgeons of England. To this extent, the text has succeeded in staying true to its aims of providing a comprehensive, surgically oriented content, logically delivered and clinically relevant. In an academic climate, where anatomy is playing a progressively decreasing role, it is re-assuring to note that the content has remained descriptive and the format rigorously structured. For example, muscle groups continue to have clearly stated origins, insertions, actions, nerves and tests, whilst the course of blood vessels and nerves is fully described. The ‘Surgical Approach’ subsections add clinical relevance to the text by focusing on the anatomical basis of surgical practice (e.g. abdominal incisions on page 240 or Kocher's manoeuvre on page 279). These serve to bridge the gap between basic science and operative anatomy. Most chapters also contain sections on development, which provides a good basic science background for postgraduate surgical exams. Anatomy is par excellence a visual subject. An anatomy textbook with poor illustrations has been likened to a surgeon with poor hands – informative but of little practical relevance. The 11th edition represents a major step forward in the book's evolution. All the images have been coloured, a large number of clinical pictures have been added and new artwork has been used to enrich the text of past editions. Previously, complex images, such as the otic and pterygopalatine ganglia (page 354, 10th edn) have gained remarkable clarity in this edition (page 377) and illustrates the great benefit colour has brought to the visual appeal of the book. Similarly, new clinical photographs manage to integrate concepts of surgical anatomy, pathology and clinical relevance. One example is the identification of the parotid duct. This is achieved by depicting a malignant bloody discharge in a patient with a parotid duct tumour – a potent and memorable image. Also, new radiographic images add further clarity and meaning to the text (e.g. inferior mesenteric arteriogram on page 255). It is important to note, however, that with the exception of certain changes, the actual text of the book has remained very similar to that of the 10th edition even though its layout has been improved. In summary, Last's Anatomy is one of the only remaining descriptive surgically oriented anatomy texts. Its 11th edition has greatly added clarity due to the new colour scheme and updated images. Consequently, it will continue to be popular not only with postgraduates studying for the MRCS examinations but also with all those who appreciate the importance of sound anatomical knowledge in clinical practice.