Atlas of muscle and musculocutaneous flaps

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  • Britrsh Journalo/ Phric Surger_v(1988),41, 101-103

    I?,* 1988 The Trustees of British Association of Plastic Surgeons

    Book Reviews

    Atlas of Muscle and Musculocutaneous Flaps. By John B. McGraw and Philip G. Arnold. Pp. xii + 735 with 984 figs. (Norfolk, Virginia: Hampton Press Publishing Co., 1986). Price $235. ISBN 0 939789 00 0.

    The two authors of this large atlas have immense experience in the use of flaps for reconstruction of major defects and have done more than their share in developing new techniques. One therefore has great expectations of them.

    The book 1s large (735 + pages) and heavy in the manner of modern plastic surgery texts. Unfortunately the binding and paper are more utilitarian than we have seen from some American publishers and seem too flimsy for a volume of this size.

    After a foreword by Ralph Millard, the book starts with a chapter on Basic Principles, before the individual flaps are described. At the end is a section on Complications and a comprehensive bibliography set out flap by flap. There is a well laid out index which would have been more useful if there was better cross-referencing to the site of the defects described.

    The main body of the book takes each type of flap in turn, starting with temporalis, taking in intmthOmCiC muscle flaps and ending with flaps on the foot. Each chapter is set out in the same way. starting with a page and a half of text dealing with Anatomical Considerations. Uses, Regional Flap Com- parisons, Disadvantages, Advantages and Complications. *Pitfalls and Donor Site. There follow full page colour photographs of cadaver dissections demonstrating the flap in question and a series of illustrative cases. This systematic approach allows the reader to find his way around the book with ease. The text is particularly valuable where it reflects the clinical experience of the authors in comparing the value of different flaps to fill particular defects. and when this is added to the enormous number of illustrative cases it is almost certain that any reader with a problem hole to fill will be guided to the best (pedicled) muscle or musculocutaneous flap to use. Free tissue transfer is not considered.

    So far. so good. But there are a number of ways in which the book is disappointing. In particular, there is little advice on how to raise each flap and how to locate the vascular pedicle safely. Some drawings would have helped greatly but, as it is, the novice will either need to refer to the original papers or have Cormack & Lambertys superb book at his elbow if he wishes to keep out ofdanger. Although the cadavar photographs are of high quality, some of the clinical photographs are appalling. The text is chatty and easy to read but often vague and sloppy where precision is required for clear understanding and the nit-picker could be kept busy for hours. More disquieting is the feeling that the authors sometimes are searching for patients on whom to try out their favourite flaps when simpler methods of repair would be preferable. What, for example, can be the justification for using a biceps femoris flap for a Clark level 2 melanoma on the thigh?

    Although it is a pity that this atlas is not better, it is still very valuable. Because of the vast clinical experience which it records. it is likely to displace from the most accessible library shelf those two books by Mathes and Nahai which have been such useful reference works until now.

    A. C. H. WATSON

    Atlas of Cutaneous Surgery. By Neil A. Swanson. Pp. xii + 177 with 78 figures. (Boston, Toronto: Little Brown &Co., 1987). Price i21.50 paperback. ISBN 0 316 82474 7.

    Neil A. Swanson is Associate Professor of Dermatology and Otolaryngology at Ann Arbor. His book is designed for every physician or surgical sub-specialist as a self-instruction reference manual pertaining to basic surgical skills.

    Apparently all third year Michigan medical students learn cutaneous surgery from this treatise, using a pigs foot as a model despite the relative lack of elasticity and subcutaneous tissue compared with human skin. Sadly the shortage of pigs trotters in summer in the cattle-rich Cheshire plains has prevented your reviewer from testing the model.

    This is a large format paperback, with large clear print mainly on the left page and illustrations mainly on the right. The text often faces the relevant illustrations. The paper is thick, pleasant to the touch and lavishly used. Margins occupy three inches of each pages eight inch width and nearly a quarter of the available vertical column height is blank.

    The books goal is to discover the fun of cutaneous surgery. One suspects that patients might find it more fun if it were left to surgeons.

    The student is spared any discussion of the principles of surgery and is treated to novel techniques, terminology and anatomy. The introductory photographs of instruments are too hazy and unlabelled to recognise the authors favourlte .Addison (sic) forceps.

    Very clear line diagrams reveal the techniques described in the discursive, repetitious text, slightly marred by poor English, in which the student is taught that Diazepam is an analgesic; that the bipolar coagulator requires grounding and that its effect can be transmitted through clamps; and in hair bearing skin beveling (sic) the incision across the hair follicles allows hair to re-grow through the scar.

    The chapter on Local Flaps provides most of the fun. The mysteries of the M-plasty, the double M, OZ. 0. A, T and AT- plasty are revealed, most with their Burrows (sic) triangles and T junction scars. Although the ellipse is the simplest advancement flap, the student is congratulated (on page 80) for having performed his first flap by halving an ellipse to leave a triangle and converting this into a cats cradle.

    Anatomy is covered in 10 lines in an appendix. The few extraordinary anatomical sketches have fewer labels. The student is spared the promised picture of the important. facial muscles and explanation of graft meshing, although fenestration is depicted (in Chapter 3: Advanced Techniques; Local Skin Grafts), lancing through the graft after it has been sewn into its bed. No mention is made of Mohs technique.

    The prefaces unanswered question is What is a Dermatolo- gist doing writing a book on cutaneous surgery? Answers on a postcard, please, with a bottle of bubbly for the best suggestion.


    Plastic Surgery. By J. H. Goldin. Pp. iv+ 198 with 36 photographs and 24 illustrations. (Oxford, London, Edinburgh, Boston, Paolo Alto, Melbourne : Blackwell Scientific Publications, 1987). Price &l 1.95 paperback. ISBN 0 632 01505 5.

    Since Eduard Zeiss Hundbuch der plastischen Chirurgie was published in 1838, there has been an explosion in the number and variety of operative techniques available to the reconstruc-