J. Boyd – Operative Microsurgery (2015)

Описание

Preface

We stand at a crossroads in the development of reconstructive
microsurgery. Having almost exhausted the finite anatomy of
the human body in the quest for new donor sites, we have
entered the realm of supermicrosurgery and free-style free flaps,
where practically any tissue may be harvested or replanted to
reconstruct our patients. In other words, we have passed from
the definite to the infinite. Indeed, the possibilities now exceed
our capacity for classification, whereas before they were limited
by incomplete anatomical knowledge as well as our technical
inability to perform the surgery. Having defined the anatomic
microcirculation of the skin, muscles, and bone, for which we
owe Professor G. Ian Taylor and his coworkers an enormous
debt of gratitude; it is likely that in the future we will look to
composite tissue allotransplantation (CTA) to reconstruct
complex defects poorly reconstructed by “conventional” microsurgical
techniques, although the huge problems of rejection
and chronic immunosuppression still remain.
Now is also the time when most of the first generation of
reconstructive microsurgeons are retiring; have retired; or, alas,
passed away. This textbook is therefore a tribute to those
microsurgeons; some of whom have emerged from the Elysian
fields of retirement, from their farms, golf courses, trout
streams and duck blinds, or merely from the contemplation of
lives well spent; to contribute their valuable and perhaps historic
experience to this textbook before it is lost forever. Their
passing from active practice may mark the end of an era—but
surely the beginning of a new one, for we stand on the shoulders
of these giants—and constitutes another justification for
the timing of this work.
We have tried to eliminate duplication and padding by
assuming a certain level of microsurgical expertise or at least
knowledge in our readers. There are no introductory chapters
on how to perform a microvascular anastomosis or a microneural
repair. These techniques are exhaustively showcased elsewhere
and best learned in vivo—preferably in an animal model.
The reader will not find any account of the history of microsurgery
or microsurgical instruments, apart from that pertaining to
some of the procedures outlined in the various chapters. The
anatomy of the human body is described in anatomical tomes
and will not be repeated here except as it applies to specific
operative procedures.
The book is essentially divided into two parts—firstly,
descriptions of specific operative techniques, each of which
should serve as a recipe for the average microsurgeon to perform
the procedure independently; and secondly, chapters on
problem-based clinical applications in each of the anatomical
areas—the head and neck, trunk, upper and lower limbs. There
is inevitably some overlap for the purposes of continuity, and
some specific chapters simply stand alone. We have made no
attempt to make this an encyclopedic work—there are several
flaps that the reader will not find here: our purpose has been to
describe flaps in reasonably common usage, so there will be
inevitable omissions. If glaring, these will of course be corrected
in any future editions. The fact that the book has had a somewhat
prolonged gestation may mean that the very latest reference
may not be cited—perhaps a future online version will
permit frequent updates to be made. Alas, most textbooks face
the same problem!
When planning this book, we contemplated who the target
audience would be. The answer is embodied in the title. The
text is aimed at reconstructive microsurgeons across the entire
spectrum of surgical specialties. These include Plastic Surgeons,
Orthopedic Surgeons, Hand Surgeons, Head and Neck
Surgeons, Oral-Maxillofacial Surgeons, and Urologists. We feel
that this book will be extremely useful to residents, fellows, and
younger surgeons starting to practice reconstructive microsurgery
in any of these fields, and will hopefully find a place in the
libraries of their training programs.
We would like to heartily thank all the authors of the various
chapters, for it is largely upon their efforts that the impact
of this book will rest. They all accepted their tasks willingly and
dedicated a significant amount of their valuable time, distilling
their unique knowledge, and putting pen to paper or, rather,
fingers to keyboard. We would particularly like to thank those
contributors whose native language is not English and therefore
their effort much greater.
Our thanks are also due to the staff at McGraw-Hill who
have consistently held our feet to the fire, yet maintained their
support throughout. These include Brian Kearns and Brian
Belval as well as our copy editor, Sylvia Rebert. Her quiet persistence
and thoroughness has been a great asset in the project
and it is to her that we owe a profound debt of gratitude.
Finally, we would be remiss if we did not acknowledge the
support of our wives, Jeanette and Barbara, who suffered
through long evenings, weekends, and vacations where the
need for internet service was paramount and the usual amusements
took second place to long spells on the laptop computer,
midnight texting to contributors, a constant torrent of e-mails,
and the inevitable conference calls. Without their unstinting
support, this book would not have been possible.