BOOK REVIEWS

Tendon transfers. Edited by W. E. Burkhalter. Phil­adelphia: WB Saunders, 1988:348 pp, $32 .00.

Tendon Transfers is published as a issue of the quar­terly Hand Clinics and includes 348 pages (12 are in­dex) and is well worth the price . The release, transfer,and coordination/balance of musculotendinous units is

·one of the absolutely essential areas of expertise forany surgeon of the musculoskeletal system. During thedays of polio epidemics, the textbooks were filled withmaterial about tendon transfers; now too little is being

·written and the student finds resource material insuf-· ficient. Somewhat dated but written with clarity and:precision was "Restoration of function and balance ofthe wrist and hand by tendon transfer" (W. L. White,Surgical Clinics of North America, 40:2, April 1960).The next contribution was this volume 's predecessor(Tendon Transfers ill the Upper Extremity. The Ortho­pedic Clinics of North America, W. B. Saunders Com­pany, April 1974).

The current Tendon Transfers reveals a great varietyof styles, formats, clarity, and experience. Organizationcould be improved. The book starts well with a tight,vital chapter on biomechanics by Paul Brand, but other­wise the "principles" are introduced willy-nilly, usuallyin the introduction portion of various chapters on spe­cific tendon transfers; timing and preoperative assess­ment is almost at the end of the book. In dealing withtheir individual areas, the authors display many ap­proaches but little similarity. Some base their recom­mendations on laboratory results, some on review ofthe literature, and some on considerable experience.Use of all three in balanced fashion is rare. Fortunately,there is meat in every presentation, and the materialwill serve the purposes of the diligent student, as didthe preceeding volume.

Though one might wish for a little more coverage incertain areas, such as the use of tendon transfers inprogressive neurologic disease, immed iate musculoten­dinous replacement in tumor reconstruction or the useof tendon transfers in congenital anomalies, there iscomplete coverage of the major problems. The rec­ommendations are soundly based, though there are dis­agreements between authors and a general disregard ofbiomechanical fundamentals in relation to clinical per­ceptions . The bibliography and illustrations are appro­priate . The index attempts to deal with the overlap andredundancies present in the material but loses the battle .

366 TilE JOURNAL OF llANO SURGERY

Basically, one must judge by chapter title whether ma­terial, relevant to the reader 's interest , wiII be there orsomewhere else. There is enormous variability in read­ability and literary quality. Some material is conciseand clear; much needs reorganization, removal of re­dundancy, rephrasing of thoughts. Tables, where pres­ent, help enormously; there are many of them, but notenough. Until a more uniform approach is produced,Tendon Transfers must and will serve as a standardresource.

James II. Dobyns, MDOrthopedic SurgeryMayo ClinicRochester, MD 55905

The hand, vol. III. Edited by Raoul Tubiana. Phila­delphia: WB Saunders, 1988:1296 pp, $225.00.

Bringing together 110 contributors, Raoul Tubianapresents the third in his four volume series , The Hand.This volume covers surgery of the tendons, nerves , andvessels, as well as the management of bums, traumaticinjuries, and amputations. The contents are both com­prehensive and extremely well presented.

The authors are selected and edited soundly and thetext is admirably even. Yet the international flavor ofthe contributors comes through and the focus is differentfrom that of a textbook that draws primarily from onenational group and its literature. Basic science researchis presented but is balanced by practical presentationson applications and technique. Anatomy and physicalexamination are stressed as in no other hand text, butsurgical technique is not slighted since multiple authorshave the opportunity to present alternative approachesto common operations. Older approaches are juxta­posed with newer techniques and end result assessmentsare provided where needed, as in the section on nerverepair.

The first 40 chapters (363 pages) cover tendon anat­omy, research, repair, grafts and implants, as well assurgical indications and results and pediatric tendonsurgery. Several chapters with an outstanding varietyof authors are devoted to the vascularity and nutritionof tendons.

The peripheral nerve is presented in 25 chapters (328pages) discussing surgical anatomy, nerve healing, andtechniques for repair and grafting. There is a very goodchapter on clinical and laboratory assessment of nervefunction, and the brachial plexus is reviewed compre­hensively including analyses of the results of plexusrepairs, grafts, and transfers . Throughout, the newerexperimental information on nerve physiology is in­cluded .

Vol. 16A, No.2March 1991

The weakest portion of this volume is the section onvascular surgery. With only two chapters, one on vas­cular assessment and the second a relatively brief reviewof vascular injuries, the deficiency lies not in what isincluded but in what is omitted. Given the depth of theremainder of the book, one expects the inclusion of arelevant subject such as vasospastic disease and morethan a brief comment on upper extremity aneurysms.

Sixteen chapters (186 pages) discuss miscellaneousinjuries including bums, freezing, radiation injuries,bites and stings, and the sportsman's hand . The chapterson the bites and the sports injuries are worthy of specialmention as thorough but delightful reading, and thechapter on therapeutic radiation damage to the brachialplexus is unique in our hand literature.

The final portion of the book consists of 30 chapters(330 pages) on amputation emphasizing its early andlate treatment. Replantation through digital transposi­tions are reviewed and the material on thumb repair andreconstruction is particularly good.

Throughout, the line drawin gs, illustrations, and his­tologic figures in this book are outstanding and theclinical photography is good and consistent. The bib­liography is excellent and a valuable resource. Thisbook has achieved its goals and will be appreciated byhand surgeons working in the operating room or in thelaboratory.

Mary H. Mcilrath, MDThe George Washingtoll University Medical Center

2150 Pennsylvania Ave., N .W.Washingtoll. DC 20037

The hand: Primary care of common problems, 2nd.ed. American Society for Surgery of the hand.New York: Churchill-Livingstone, 1990: 173 pp,$12.95. The hand: Exa"inination and diagnosis,3rd ed. American Society for Surgery of theHand. New York: Churchill-Livingstone, 1990:136 pp, $12.95.

The Editor asked me to review the latest editions ofThe Hand: Examination and Diagnosis, and The Hand:Primary Care of Common Problems. He felt that itwould be useful to get the viewpoint of a resident ratherthan someone who is well established in the field.

The Hand: Examination and Diagnosis. This bookis very successful in presenting a significant amount ofmaterial in a simple, concise, and effective fashion . Allsections are well written and the new sections aregreatly appreciated. I think a section addressing wristinjuries would be appropriate in this book, even thoughthis is addressed in The Hand: Primary Care of Com-

Book re~'iell's 367

mon Problems. The only particular detail I found thatdemanded attention was Figure 59, which is labeled asbeing a midpalmar space infection and is actually arepeat of the diagram for a thenar space infection. Ialso felt that it would be helpful to mention in thediscussion on human bites the importance of flexingthe metacarpophalangeal (MP) joint when evaluatingthe possibility of an open joint caused by a lacerationsustained from striking one in the mouth with a fist.

The Hand: Primary Care of Common Problems.Even though the basic purpose of the book is to relateto the primary care physician, the book provides anexcellent basic foundation for a developing hand sur­geon by its simple and insightful explanations. It doesa good job of delineating the limits of what should bedone by those who are not hand specialists, but it needsslightly more emphasis on ensuring that appropriatehand referrals are made, since this book does not setout to be a complete guide to the care of the hand.

The guidelines on how to effectively care for thehand in the emergency room setting are very useful. Itwould have been helpful to perhaps suggest a practicalmeans of exsanguination in this setting by use of anAce wrap in lieu of an Esmarch, increasing the ease ofthe examination in the emergency room with an armtourniquet. I would have made a point about perpen­dicular passage of simple sutures to increase eversionof the skin in the section discussing suture techniquesin relation to the hand . The guidelines for the dosageof lidocaine for Bier block were appropriate for anadult, but I felt that some mention of an appropriatebody weight dosage for children would have been help­ful. I would have discussed the minimal length of timethe tourniquet should be inflated, i.c., 20 minutes. Ialso would have discussed releasing the tourniquet fora few seconds at a time to allow circulation of newblood into the extremity and increased metabolism lo­cally before releasing the tourniquet completely.

The section addressing splinting and dressing of thehand is very practically written and helpful. The optionsfor controlling serious hemorrhage without ligating orclamping vessels is excellent advice. In the section onrelative indications for replantations, the mention of"the hand" being an indication should perhaps beenreworded into saying "the palm of the hand" so to avoidany vagueness. I would have included upper arm levelof amputation in the list of contraindications to replan­tation. A brief discussion on basic principles and howthey dictate an appropriate level for replantation attemptwould have been helpful and very informative for thecurious reader. In the section addressing drainage offelons, I would have made some mention of the pre­ferred lateral site. i.e., radial versus ulnar in relationto which finger was involved and how it relates to