Book Review

Arteries of the Muscles of the Extremities and the Trunk (Book 1); Arterial Anastomotic Pathways of the Extremities (Book 2)

N Engl J Med 1994; 330:1692-1693June 9, 1994

Article

Arteries of the Muscles of the Extremities and the Trunk (Book 1); Arterial Anastomotic Pathways of the Extremities (Book 2)
(Michel Salmon Anatomic Studies.) Edited by G. Ian Taylor and Rosa M. Razaboni. 307 pp., illustrated. St. Louis, Quality Medical, 1994. $90. ISBN: 0-942219-27-9

Over the past 25 years there has been an explosion of new techniques and procedures in plastic and reconstructive surgery. This progress is due to an improved understanding of the blood supply to the tissues of the body, and it has allowed the rapid and complex reconstruction of traumatic and ablative wounds. Successful reconstruction with vascularized muscle and cutaneous flaps, replantation, and microsurgical free-tisssue transplantation depends on detailed knowledge of the network of axial blood vessels in the body and their direct contributions to muscle, bone, and skin. This need has prompted a return to the cadaver laboratory and a resurgence of interest in anatomical dissection and investigations of the dynamic changes in circulation after injury. Dr. Taylor, an internationally known contributor to the study of anatomy, has collaborated with Dr. Razaboni to translate into English two books by the French anatomist Michel Salmon that were written in the 1930s.

This new book has four sections; the first two commemorate the life and legacy of Dr. Salmon, and the latter two translate his works Les Arteres des Muscles des Membres et du Tronc, written with Dr. Jacques Dor in 1933, and Les Voies Anastomotiques des Membres, published in 1939.

In the first section, the history of Dr. Salmon's life and work is placed in the context of the wars in Europe; the publication of his first book at the age of 30 years, at the time of his promotion to assistant professor of anatomy, is noted. Salmon devised a method of injecting blood vessels with radiopaque dyes and systematically mapped the arterial anatomy of the trunk and extremities, combining cadaver dissection with x-ray examination. The latter technique, unavailable to previous anatomists, serves as the inspiration for contemporary work by Taylor and others.

The second section, entitled “Michel Salmon: His Legacy,” should be required reading for all students of anatomy and surgery. While paying tribute to Dr. Salmon and his pioneering work, Dr. Taylor reviews the basic building blocks of our current knowledge of the blood supply and places it in the larger context of the arterial and venous circulation and the dynamic changes that occur with vessel injury or occlusion. Taylor's own detailed work on the angiosomes of the body, which defined major source arteries for regions of tissue, expands on Salmon's work to provide information relevant to all branches of contemporary surgery, including the use of axial blood supply to maintain tissue perfusion and the use of reconstructive flaps. Taylor also discusses the anatomical basis of the “delay” phenomenon, in which planned division of the blood supply provides a more robust circulation for later reconstruction.

The third and fourth sections are translations of Dr. Salmon's two pioneering anatomical works. They include his original drawings, photographs of his x-ray studies, and a detailed narrative of his dissections. The editors have included Salmon's comments on the similarities and differences between his own findings and the work of his contemporaries and their influential mentors -- a historical context in which his findings must be viewed. The drawings, although detailed and elegant, bear few labels, and a solid knowledge of anatomy is required to follow his descriptions. This book is not, therefore, a beginner's anatomical atlas, but it will appeal to readers interested in expanding their knowledge of the regional anatomy of the extremities of the trunk.

The first book reprinted here, which concentrates on the arterial anatomy of the limbs and trunk, makes up the bulk of the work. The second, based on experiments in which arterial injections of dye were performed before and after ligation of key vessels, provides insight into the body's capacity to create collateral circulation after vessel ligation and suggests certain danger zones in which injury to vessels may result in the loss of a limb.

Drs. Taylor and Razaboni have created a book that is both a tribute and a resource that recognizes the historical foundations of our present knowledge. It will appeal to readers with an interest in the anatomy of the extremities.

Timothy M. Whitney, M.D.
Lahey Clinic Medical Center, Burlington, MA 01805