Title: Surgical Disorders of the Peripheral Nerves.
Abstract: Surgical Disorders of the Peripheral Nerves. By R. Birch, G. Bonney, and C. B. Wynn Parry. Pp. 539. Churchill Livingstone, London, 1998. Price $150.00. The surgical management of peripheral nerve lesions, either traumatic or acquired from other causes, has shown a significant improvement over the past 20 years as a result of improvements in basic laboratory experimentation, the use of the operating room microscope, advanced knowledge of the internal anatomy of the peripheral nerves, and sophistication in clinical repairs. The authors of this text have attempted to cover the entire field, and in many respects, they have achieved this objective. Their bibliography is extensive, although somewhat selective—a number of important publications have been omitted. It would be my preference to have the pertinent bibliographic references listed after each chapter rather than as a compendium at the conclusion of the book. There are several outstanding chapters within the text; these include the presentation on pain control, reconstruction for late muscle paralysis, and rehabilitation. Chapter 15 on pain could be published as a separate book, and its contents should be read and studied by all who are involved in peripheral nerve surgery. The reconstructive aspects for late median, ulnar, and radial nerve lesions include an excellent summary with a listing of standard techniques and some analysis of the results. The rehabilitation aspects are also well covered, which obviously requires a coordinated team of physical medicine specialists along with related personnel. Chapter 19 on electrodiagnosis by Shelagh Smith is clearly written for appropriate diagnoses and localization of compressive neuropathies. The limitation of these techniques is also included. I particularly liked the presentation on nerve tumors for the authors’ learned analysis and treatment process. In the section on brachial plexus, the authors review 65 cases of vascularized ulnar nerve grafts, 149 direct brachial plexus repairs, and 403 cases of nerve transfers. They stress the importance of early repair of brachial paralysis and include good discussion on the recent introduction of contralateral C7 transfers for root avulsions. The section on reimplantation of ruptured nerve roots from the cervical cord includes the first case in 1977 by Mr. Bonney and also describes the laboratory and clinical experience of Dr. Carlstedt and the thoughts for future application of this technique. The authors’ discussion of vascularized nerve grafts is interesting, although their conclusions require discussion. The microsurgical approach to neuromas in continuity is somewhat scanty, and the use of intraoperative fascicular stimulation techniques is barely discussed. The entrapment neuropathies are approached in an evaluative manner with stress on individual assessment, and the late management of patients with poor results is well handled. The authors also discuss the use or disuse of endoscopic techniques for release of carpal tunnel syndromes. They introduce the term “iatropathic injury” and compare this descriptive term with well-established “iatrogenic surgical injury.” In many respects, the term “iatropathic” is more descriptive and probably more correct from a linguistic aspect, although it will be difficult to replace the commonly used iatrogenic description. On my review, I was somewhat troubled by the authors’ failure to mention the work of Ytterbo and others on end-to-side nerve grafting and by the omission of publications by certain authors, such as Chiu and Strauch, on tubulation techniques. I also question the authors’ statement that the rate of nerve regeneration is faster in children because it may well be related to the shorter distance that the nerve has to grow before it reaches its end organ. In summary, the book is an excellent treatise that should serve as a valued resource for beginners and experienced surgeons and for those in related fields with a major interest in peripheral nerve surgery.