New Ideas in Hand Flexor Tendon Surgery
Edité par J.C.Guimberteau
Aquitaine domaine forestier
ISBN 2-84023-268-5
Prix : 108 euros
© 2002 The British Society for Surgery of the Hand
doi: 10.1054/jhsb.2002.0790, avalaible on at http://www.idealibrary.com
This work is a «concept» book which introduces its reader to the key concepts regarding the anatomy of the sliding system and the salvage of the failed tendon repair/tendon graft using autogenous sliding vascularized tendon transfer. It also presents those cases of homotransplantation of the flexor sliding system previously published by the author. This book challenges current thinking regarding the flexor tendon as a simple "transmission belt" and the desirability of promoting "supple adhesions".
Dr. Guimberteau presents a personal overview, and indeed a lifetime synthesis of his own work and that undertaken in collaboration with others, of the flexor tendon system. We are taken on a fascinating journey through his own research, much of which has unfortunately not been specifically published elsewhere. There is therefore a great deal of unpublished observation, and much of this work is not referenced and is not presented in standard scientific format. However, a coherent argument is carefully presented and extensively illustrated. In the final phase of his book Dr. Guimberteau modestly suggests that the ideas proposed in this book may rapidly become obsolete as more knowledge of the system is gained. It may be some time before the hand surgery community catches up with his developments but where he has shown the way others will surely follow.
Dr. Guimberteau makes a number of important points both on clinical and philosophical levels and we should certainly accept his challenge to develop his particular line of thinking further. However, I would take issue that the existing clinical problem, as outlined in his introduction, is of the magnitude that he claims, i.e. that the majority of flexor tendon grafting tends to be associated with poor results. Good results ca, normally be expected with the appropriate surgical expertise and a cooperative patient. The more complex procedures for flexor tendon reconstruction outlined in this book would probably be best avoided, when either of these key elements is lacking.
It must be said that many of the photographs are of poor quality and I suspect that some of the examples pre-date the current generation of quality digital imagery. Nonetheless, the illustrated points are clearly made. Some of the computer-generated summary diagrams are complex and have not reproduced particularly well when scaled down for the book. The text of the book is kept to a minimum and the format is visual as far as possible. The linguistic style is engaging and readable but is more akin to lecture notes than to format text. Occasionally, the argument becomes difficult to follow because of poor selection of terminology.
The book is divided into sections on the anatomy, physiology and the various operative techniques of replacing the sliding flexor system. Specific case examples are detailed for each of the operations described. Many of the cases described had apparently suffered reflex sympathetic dystrophy in association with their first surgeries and prior to treatment in Dr Guimberteau's unit. In the post-operative period the patients had appropriate physiotherapy and did not experience recurrence of this problem.
The operation section takes us through the grafting of a single flexor sliding unit bades on a distally-based pedicle of the ulnar artery. Modifications of this basic operation include the addition of the multiple tendon units on the same pedicle, with the ion of incorporation of a skin paddle and even a boney block. Case examples of vascularized tendon composite tissue allografts are detailed in the final section.
This is not a book for the general trainee, but rather for the practising hand surgeon and those currently working as hand fellows. These surgeons should familiarize themselves with the important ideas contained in this fascinating book. More questions are raised than answered, but it is certainly a fascinating read and deserves a place in the departmental library.