Surgical Disorders of the Peripheral. Nerves. By R Birch, G Bonney and CB Wynn Parry. 540 pages ... away from concentrating nerve injuries in specialised units: 'we have ... the theorised simplicity of Sunderland's classification system for ...
BOOK REVIEWS
Surgical Disorders of the Peripheral Nerves By R Birch, G Bonney and CB Wynn Parry 540 pages Churchill Livingstone: Edinburgh, 1998 £100. ISBN 0 443 04443 0
Like its distinguished progenitors, this completely rewritten edition of Surgical Disorders of the Peripheral Nerves is exceptional in several ways and whilst its place as a classic is assured, it may attract something of a cult readership also. This is because, unlike so many authoritative works in surgery, this is a fluent work from which the styles and personalities of all three principal authors shine. Each has a claim to authority in this field, and what a joy to find such authority displayed in opinion and experience, illustrated by clinical anecdote and example. This alone makes the book more readable than any other text I know, and commensurately more rewarding. Add to this the pleasure of literacy and erudition not normally associated with surgical texts, and a conversational style that engages the reader: whether it is in the excellent asides (for instance comparing the efficacy of conservative treatment with that of conservative government) or in the teasing pedantry (iatropathic replaces iatrogenic) or in the elegant expositions (the short diatribe on medicolegal principles is clarity exemplified), this book consistently intrigues and delights. A typical example is the repeated (and appropriate) bemoaning of the trend away from concentrating nerve injuries in specialised units: 'we have already remarked on the great advances that flowed from the establishment, under the hammer of war, of such regional centres. It is, however, vain to repine: surgeons must do what they can'. As for clarity, one could scarcely better the single paragraph in which the significance of Tmel's phenomenon is so elegantly elucidated that even this reviewer, who has striven for years to impart the value of this sign to trainees, learnt more.
Each of the treatise on peripheral nerve surgery with which this edition shares lineage has had its own emphasis and contribution. This volume strays from the theorised simplicity of Sunderland's classification system for nerve injury, but substitutes a clear description of nerve injury and its sequelae that is more descriptive. Welcome additions (that reflect the great expertise at the Royal National Orthopaedic Hospital) are chapters on obstetrical brachial palsy, iatropathic
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(why not iatrogenous?) nerve injury, and electrodiagnosis. The contributions on tumours of nerve origin, and on recovery of sensibility are expert and welcome corrections of deficiencies in earlier texts, whilst Dr Smith's description of electrodiagnosis is succinct and compelling. The occasional nerve surgeon will find clear descriptions of surgical approaches and operative technique, but will also take caution and pause for thought when he or she encounters the many homilies on the complexity of the evaluation and management of these most difficult of cases: joining the nerve is simple, managing the patient and the sequelae of injury is more demanding of skill and experience. Faults? Of course there are some. Small editorial mistakes are quite easy to find, some references are cited and do not appear in the bibliography for instance. The index is not as helpful as it might be. These are trivial. So is any objection to the chapter order which is idiosyncratic (why not place electrodiagnosis after clinical aspects of nerve injury, or recovery of sensibility with results?). Some areas of controversy are presented as resolved when others might disagree, for instance the use of freeze thawed muscle grafts (referred to in one part as freeze dried muscle grafts!) or the place of guanethedine blocks in management of reflex dystrophy. It is fun to catch occasional misuses that offend the pedant such as anastomosis for nerve repair. But none of this seriously detracts from the value of the publication. The point about this book is that in the era of the eight minute presentation, the comprehensive web-retrieved reference list, and the spell checker, here is a readable text with gravitas and personality that does its job expertly, clearly and without patronising. What is more it is unashamedly British, not subservient to a huge American market but aimed at the intelligent and inquisitive surgeon whatever his or her level. As the authors remark: 'we even hope that undergraduates will come to no great harm through reading it'. Indeed they will not, and nor will any surgeon treating the peripheral nervous system. This is a reference book that will be read and re-read for information and pleasure and I recommend it most strongly. Enjoy.
SIMON KAY Consultant Plastic Surgeon The Children's Hand Clinic St James's University Hospital Leeds, UK
Ann R Coll Surg Engl 1999; 81
