Microsurgery in trauma

Abstract

Microsurgery in trauma William W. Shaw and David A. Hidalgo. Mt. Kisco, 1987, Futura Publishing Co., 407 pages, $87.50. This well-illustrated book stems from the work of a small, experienced group of surgeons in a single department of surgery. The vascular surgeon involved in the microsurgical aspects of trauma care will find in this book a comprehensive atlas of most of the free flaps used today in the immediate and delayed reconstruction of traumatized tissue. The remainder of the volume deals with aspects of microsurgery less pertinent to the vascular surgeon but important to others practicing microsurgery. The introductory section on the basic techniques and practical aspects of microsurgery covers magnification, sutures, monitoring techniques and equipment, instruments, vessel preparation, and microanastomosis. The book is not detailed enough to serve as a laboratory manual of the techniques of vessel preparation and microanastomosis; however, it does discuss some of the practical problems microsurgeons will encounter. These problems include ways to deal with vessel size discrepancy, the indications for end-to-end as opposed to end-to-side anastomosis, and the fine points of performing an arteriotomy. The section on replantation gives an overview of anatomic areas (upper and lower extremities, scalp, and penis) where replantations have been successfully performed and summarizes the results without delving deeply into the more controversial issue of the criteria for selecting suitable candidates for replantation. The section on nerve injuries provides a good overview of surgical exposures and indications for nerve repair, and it describes the various types of repair (epineural, group fascicular, combined epineural-perineural, fascicular, and nerve grafting) in a manner that clarifies what can be confusing terminology. There are some problems in this book. The authors sometimes fail to cite additional references that might be of value to the reader. They deal only superficially with microsurgical procedures for the late reconstruction of brachial plexus injuries. They also tend to laud the use of nerve grafts as a means of primary nerve repair in spite of the fact that no one has shown the superiority of nerve grafting in those situations in which end-to-end repair can be achieved without tension at the suture line. Nonetheless the discussion of tissue transplantation alone would make this book a useful addition to the library of any vascular surgeon involved in microsurgery.