Christopher Jordan and Edwin Mirzabeigi. New York:
Thieme Medical; 2000. 218 pages. $149.00.
The authors provide two reasons for having written this text:
to more closely approximate the visual and technical realism found
in actual patients at surgery, and to describe the anatomical landmarks and
point out how to avoid problems with each approach. Sections I through
VI cover the upper extremity from the shoulder to the hand, sections VII
through XII cover the lower extremity from the hip to the foot,
and section XIII covers the spine. Each section is organized into
seven subsections: "Uses," "Advantages," "Disadvantages," "Structures
at Risk," "Technique," "Tricks," and "How
to Tell if You Are Lost."
The text’s strengths include the color photographs that
are used throughout to illustrate the anatomical areas. The structures
in each set of photographs are labeled with use of a numerical system,
and each is accompanied by a legend. This provides a good visual
reference for confusing statements in the text. Information on how
to avoid or repair anatomical structures that are at risk is often
repeated in different parts of the text, reinforcing the value of the
descriptive material. For example, in the section entitled "Superior
Approach to the Suprascapular Nerve," the admonition that
the suprascapular artery can pass superior to the suprascapular
ligament as the suprascapular nerve passes inferiorly is repeated
in the subsections "Structures at Risk," "Technique," and "Tricks."
The text also has some weaknesses. In several sections, the views
of the skin incisions are too close to the subject to satisfactorily
orient even the experienced anatomist or surgeon. This prevents
the reader from clearly visualizing the appropriate locations of
the incisional sites. For example, the views of the skin
incisions associated with various approaches to the shoulder (such
as the deltopectoral approach, the posterior approach, the superior
approach to the suprascapular nerve, the approach to the acromioclavicular
joint, the anteromedial approach, and the lateral approach to the humerus)
and the elbow (such as the anterolateral, posterolateral, and posterolateral/anconeus approaches)
are so close that it is difficult for the reader to know where
these incisions are located on the anatomy. In contrast, the views
of the incisional sites on the forearm and hand are excellent, appropriately
orienting the reader visually. The depictions of skin incisions
in the lower extremity are similarly both confusing and illuminating;
those of the pelvis, thigh, and leg are the least helpful while
those of the knee, ankle, and foot are excellent.
There are a number of inaccuracies in the text, mostly in the
form of omissions of appropriately placed words. For example, in
one of the subsections entitled "Tricks," the
first sentence states that "the major trick is to find
the deltopectoral groove and take whichever vein seems easiest (typically laterally)." That
sentence probably needs to read "the major trick is to
find the deltopectoral groove and take the cephalic vein
whichever way seems easiest" instead of the way it is structured.
In the subsection on the technique for the deltoid-splitting approach,
the first two sentences are confusing and may give the inexperienced
reader the impression that these incisions are oriented similarly,
with only the starting location being different. Another confusing
sentence, in the second paragraph of the subsection on the technique
for the superior approach to the suprascapular nerve, states: "If
there is a large amount of fat between the two muscles, then remove
it or retract it so you can see the supraspinatus and the suprascapular
artery." No clear explanation is given as to which two
muscles are meant. This information would have been more appropriately
placed in the previous paragraph.
Routinely encountered anatomical variations are not described.
For example, no mention is made that the course of the musculocutaneous
nerve through the short head of the biceps is variable. A notation
about the percentages of variability of the location of this nerve
would also be helpful. It is mentioned that the nerve has been reported
as exiting the short head of the biceps within 5 cm of the coracoid.
Another confusing statement that detracts from the value of the
text is found in the section on the use of the posterolateral approach
to the elbow. The first sentence of that section states that "this approach
is the lateral equivalent to the approach to the ulnar nerve," which
is really not factual.
If the authors wish to fulfill the stated goals of this book,
areas of confusion should be clarified, anatomical variations of
structures should be identified, and references (such as Extensile
Exposure, by Henry), should be added. (There are no references
anywhere in the text.) These changes could make this a creditable,
useful reference text.