Book Review

Atlas of Microvascular Surgery: Anatomy and Operative Approaches

N Engl J Med 1993; 329:974September 23, 1993

Article

Atlas of Microvascular Surgery: Anatomy and Operative Approaches
By Berish Strauch and Han-Liang Yu, with Zhong-Wei Chen and Ralph Liebling. 560 pp., illustrated. New York, Thieme, 1993. $195. ISBN: 0-86577-436-6

This surgical atlas is a testament to the progress made in microvascular surgery since its inception two decades ago. Appropriately, the book was coauthored by surgeons in the United States and China, where much of the pioneering and refinement in the field took place. Containing numerous illustrations, it consists of a systematic review of 43 donor sites and 39 recipient vessel exposures for free-tissue transfer. The subjects are grouped according to anatomical regions, and an orderly format is followed. For each flap, the pertinent anatomy is first described, and its arterial and venous diameters are generally listed in a table. Potential variations in vascular anatomy are thoroughly reviewed and illustrated. A “comment and insights” section discusses the flap's clinical applicability and its associated benefits and drawbacks. The technique for harvesting the flap is then depicted in a step-by-step manner. Variations in flap design for different clinical uses are included. For example, the radial forearm flap may be used as a fasciocutaneous free flap, a neurosensory free flap for penile reconstruction, a reverse island flap, an osteocutaneous flap, or a tendinocutaneous flap. A bibliography containing most of the published work on the subject is found at the end of each chapter.

The greatest strength of this book lies in its abundant illustrations by Li-Guo Liang. They are exceptionally clear. The concise textual descriptions, legends, and illustrations are coordinated with microsurgical precision. Although there are occasional minor inaccuracies in the drawings, their value in delineating the anatomy of each flap cannot be overstated. The exposure of recipient site vessels, often neglected in other textbooks, is treated with equal emphasis and should be quite useful. Reconstructive surgeons contemplating the choice of flaps will find helpful perspective in the comments and insights drawn from the authors' experience.

The purpose of this book is not to present a comprehensive review of the clinical experience with each free flap. For example, there are no representative cases or clinical photographs, although the complete bibliography should provide material for in-depth study. This atlas, therefore, is most valuable as a reference for surgeons who wish to learn about a new flap or to reinforce their knowledge of the relevant anatomy before undertaking a microvascular procedure.

The goal of this book, the authors state, is to “make the techniques of free tissue transfer convenient for surgeons to approach.” The authors have succeeded and ought to be congratulated for making an important contribution to the libraries of practicing microvascular surgeons.

W.P. Andrew Lee, M.D.
Massachusetts General Hospital, Boston, MA 02114