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Operative Techniques in Hand, Wrist and Forearm Surgery

Thomas R. Hunt III and Sam W. Wiesel pp. 980 Philadelphia: Lippincott Williams and Wilkins, 2011 ISBN: 978-1-4511-0255

This is a large, single volume text that aims to comprehensively cover the surgical procedures used to manage disorders of the distal upper limb. The editors have collated contributions from more than 180 respected hand and upper limb surgeons into 120 chapters organised into twelve sections. The coverage is very comprehensive and commences with chapters on anatomy, surgical approaches and regional anaesthesia techniques and proceeds to detail procedures to manage most conditions and problems encountered in the forearm, hand and wrist. I struggled to think of a standard operative procedure which was not covered, and many less widely performed (and perhaps somewhat esoteric) procedures are included, such as arthroscopic management of thumb ulnar collateral ligament injuries.

By aiming to be comprehensive in a single volume, inevitably there are some areas where more in-depth coverage would be welcome - for example the topic of Dupuytren's disease in my view, as it is such as commonly encountered problem, could have been given more detailed attention (and some would take issue with the illustrated technique of skin grafting). The management of soft-tissue defects is also inevitably covered relatively superficially, but there are alternative texts specifically dealing with this topic.

The book not only covers operative techniques but also emphasises elements of history and examination (there is even a photographic glossary of examination techniques appended to the book), relevant anatomy, imaging techniques, differential diagnosis and alternative treatments including non-operative. The text is lavishly illustrated by line drawings of outstanding quality and also radiographs and intra-operative photographs. The quality of printed reproduction of some of the radiographs and photographs is somewhat disappointing, but all appear clearer in the on-line version. This is definitely a reference book; 1040 pages of closely packed text do not make for easy casual reading, but it is very well organised and the index is comprehensive so it is easy to quickly find specific topics and procedures. Weighing over three kilograms, the book is too large and heavy to be readily portable but as with many new texts, it is supported by excellent on-line content. The entire text is reproduced on-line via a website accessed using a "scratch-off" product key printed on the inside cover of the book. If anything the online content is superior to the printed version - the radiographic and photographic illustrations appear clearer, and the search engine is rapid and excellent. In addition all the images are separately available as a downloadable image bank in .jpg or .pdf format forming an outstanding image reference library for teaching. Clearly no book can provide details of all possible alternative operative procedures but the value of this book lies in the distillation of the knowledge and experience of very well respected practitioners in each area and the clear demonstration, step by step, of their preferred techniques, together with carefully considered 'pearls and pitfalls'. This makes the book particularly valuable for the trainee or inexperienced practitioner, but there is also value here for the experienced surgeon.

Several competing operative techniques textbooks are available but I was impressed by the breadth, clarity and detail of this book and particularly the quality of the online content. It is a very useful reference text for trainees and more experienced surgeons. The online link is amongst the 'favourites' on my computer and I have certainly very usefully referred to it several times over the past few weeks.

N. D. Downing

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