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Surgical Disorders of the Peripheral Nerves (Second ed)

Rolfe Birch pp. 645 London: Springer, 2011 ISBN: 978-18488107-1

The first edition of this book, published in 1998, was a landmark in the study of lesions of the peripheral nerves; combining original work on the basic sciences with clinical diagnosis, investigation and techniques of repair. As sequel to H. J. Seddon’s earlier classic text, it was not only the best work to have appeared on the subject, but also it preserved the essence of the unique British influence on the treatment of nerve injury.

This second edition of the work surpasses the first. Completely re-written and updated by Professor Rolfe Birch, it is, quite simply, a masterpiece. There is much greater emphasis on the causes and manifestations of injuries to nerves, particularly iatrogenous injury and ischaemia. The continued follow up and analysis of the author’s experience of more than 6000 nerve injuries provides a more definite, indeed, decisive edge to proposals for treatment. Important new information is introduced, notably on compound nerve injury, birth injury of the plexus, and rehabilitation. The work is also a fitting tribute to Mr George Bonney, foremost of the founders of the modern school in nerve surgery. He died before the new edition was published but contributed significantly to early preparation and the structure of the book.

The text holds to the format of the first edition, beginning with the fundamentals of anatomy and function of the peripheral nervous system; the new and well illustrated essay on the relation of nerves at risk from musculoskeletal injury must surely become required reading for all surgeons in training. There follow chapters on nerve injury and regeneration in which understanding of the cellular and molecular events that underlie nerve repair and recovery are described, and an excellent chapter on clinical manifestations of nerve injury that highlights the significance of worsening pain and the deepening of the nerve lesion caused by expanding haematoma and ischaemia.

Drs Shelagh Smith and Ravi Knight have updated their outstanding chapter on Clinical Neuro-physiology. The account of operating on nerves contains much valuable information on the principles and methods of nerve repair. Exquisite new illustrations of extensile exposures, based on the work of A. K. Henry, compliment many new fine colour intra-operative photographs. There is also sage advice on avoiding errors in diagnosis and on the hazards of surgery in entrapment neuropathy and tumours.

On compound nerve injury, the author discusses new and important work on conduction block following blast injury, and the indications, timings and operative procedures for missile wounds. Two superb chapters on the closed supraclavicular lesion, and the birth lesion of the brachial plexus provide critical analysis of the author’s extensive experience and that of other’s, in nerve repair, and late reconstruction for secondary deformity. A salutary chapter on the growing problem of iatrogenous injury highlights the problems of delay in diagnosis and of the lack of provision of urgent specialist treatment for the injured nerve. Professor Tara Renton introduces new work on iatrogenous injuries to the trigeminal nerve in oral and maxillofacial surgery. There is new and compelling work on neuropathic pain, which informs us that surgery is usually successful in causalgia, neurostenalgia and brachial plexus pain, but much less so in post traumatic neuralgia. There is a most important discussion on latent nerve injury, a theme which runs throughout this book, and the danger of the indefinite term ‘chronic regional pain syndrome type I’, for the painful, stiff, and swollen part after fracture or soft tissue injury. The message is clear for all: When pain follows wounding of a nerve, fracture, foreign body expanding haematoma, or other arterial injury, or results from damage inflicted during operation, then exploration should be undertaken urgently.

Finally, there are exceptional chapters on surgical reconstruction and rehabilitation in which there is particular emphasis on the lessons learned, and relearned under the hammer of war in reclaiming function in painful and paralysed nerve-injured limbs.

This new edition of Surgical Disorders is a great work. It is beautifully produced, elegantly written, and splendidly readable. The text is referenced to encyclopaedic standard, and richly enhanced by many new colour photographs, explanatory line diagrams, and clear summary tables, all of a universally high quality. It is strongly recommended to neurologists, orthopaedic surgeons, neurosurgeons and plastic surgeons, in practice and in training with an interest in this difficult field, and also those physicians engaged in rehabilitation after severe neurological injury. Indeed, there is something for the scholar, as well as the physician, for no reader of this book will fail to realise the impact that British surgery of the peripheral nerves has had on the progress and advance of the science and art of Surgery itself.

M. Stewart

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