Surgical Disorders of the Peripheral Nerves

SURGICAL DISORDERS OF THE PERIPHERAL NERVES. Rolfe Birch, George Bonney and C.B. Wynn Perry. 539 pp. Illust. Churchill Livingstone, Edinburgh; Harcourt Brace & Co. Canada, Ltd., Toronto. 1998. Can$247. ISBN 0-443-04443-0

This book represents a continuation of the classic work Surgical Disorders of the Peripheral Nerves by Sir H.J. Seddon. The introduction to this text makes most interesting reading. The history of H.J. Seddon and the development of the Peripheral Nerve Injury Unit in Oxford, UK, are reviewed, and new developments in this field are incorporated. Generally, the layout of the original book has been retained, but the text has been rewritten.

The book comprises 19 chapters, which cover basic science including the anatomy, histologic and pathological features of nerve injury, surgery, reconstruction and associated areas such as pain and electrodiagnosis. At the top of each chapter is an outline of the topics covered; it is hard to read and not very helpful. The distinct nature of the writing style makes for easy reading and is a major strength of the book. For example, excellent reviews of anatomy, nerve structure and nerve injury are only 68 pages long, and much of this is taken up by figures. Clinical aspects of nerve injury provide an excellent review. The chapter “Operating on peripheral nerves” provides a short, concise description of basic principles and the surgical approaches to peripheral nerve injury — how to deal with a nerve lesion — and the various surgical exposures of peripheral nerves in the upper and lower extremities. The chapter on compound nerve injury reviews the more complex problems associated with vascular and skeletal injury. The method of injury and the anatomic location (dislocation of the shoulder, false aneurysm, missile injury) are discussed. The chapters on traumatic lesions and birth lesions of the brachial plexus are relatively large. Entrapment neuropathy involving the thoracic outlet, wrist and elbow receives the greatest attention, but the lower limb is also reviewed. The chapter on iatropathic or iatrogenic nerve (injection, surgery, radiation, anesthesia) provides an excellent summary of the different aspects of potential nerve problems related to everyone who performs interventional procedures.

Pain receives adequate attention. Reconstruction focuses on the different operations to restore lost function after peripheral nerve injury. Volkmann’s ischemic contracture as well as a review of some of the more common operations performed in the upper and lower extremity are presented, based on the authors’ own clinical experience. One chapter is devoted to electrodiagnosis.

This book summarizes the clinical practice of surgery of the nervous system. I highly recommend this book for students, residents and all surgeons wishing to update their knowledge in this field. This text relates basic science to clinical practice and discusses the present state of knowledge in a clear, concise format. It provides a review for different aspects of nerve injury both from the point of view of mechanisms and anatomic location in an easy-to-read format.

The main weakness of the book is in the figures and in its format: colour plates are placed at the beginning and all references at the end. For clinical surgeons this format does not enhance the text.