Functional and Aesthetic Reconstruction of Burned Patients. Edited by Robert L. McCauley. Pp. 579. Taylor & Francis Group, Boca Raton, Fla., 2005. Price: $199.95.
Robert L. McCauley shares his extensive reconstructive experience at the University of Texas, Galveston Shriners Hospital for Children. This book is a timely update to the burn reconstruction books by Garry Brody (Rehabilitation and Reconstruction of the Problem Burn Patient, Mosby-Year Book, 1990) and Bruce M. Achauer (Burn Reconstruction, Thieme Medical Publishers, 1991) from the early 1990s.
In the preface, McCauley makes the point that tremendous strides have been made in reducing the mortality rate of burns; however, many of our patients are left with significant deformities that make normal interaction in society difficult. A cursory review demonstrates the challenging cases that he has treated and how innovative treatments can truly help these patients. He also challenges us and emphasizes the need for further development of better reconstructive methods.
The book is divided into 39 chapters, of which McCauley is a co-author of almost half. This helps the flow of the book and avoids duplication among the chapters. Most of the co-authors are from the Galveston unit, with notable U.S. authors, such as Steven Boyce, and international authors, including Nelson Piccolo from Brazil and Fu-Chan Wei from Taiwan.
The early chapters begin by reviewing the basics of skin anatomy, wound healing, acute burn care, and surgical science. They are followed by chapters on techniques such as skin substitutes, microsurgical free-tissue transfer, laser treatment, and tissue expansion. The remaining chapters describe in detail the treatment of different body areas, with an emphasis on aesthetic units.
McCauley has obtained permission to publish several classical anatomic and schematic drawings in the text. As such, this book is a very nice compilation of these classical drawings, such as those of the eyelid and the skin.
I particularly liked the chapter on reconstruction of the burned ear. The book not only reproduces the diagrams published by N. H. Antia and V. I. Buch (“Chondrocutaneous Advancement Flap for the Marginal Defect of the Ear,” Plast. Reconstr. Surg. 39: 472, 1967) and M. B. Donelan (“Conchal Transposition Flap for Post-Burn Ear Deformities,” Plast. Reconstr. Surg. 83: 641, 1989), but it also shows some impressive cases that McCauley has treated, including massive ear scar hypertrophy (p. 308).
As with any multi-authored text, the book is not perfect. In the first chapter, many of the figure legends do not match up with the figures. The photography, while excellent, is mostly in black and white, which makes it difficult to assess the final appearance of many of the scars. I would have liked to see more cases involving new technologies, such as skin substitutes and prefabricated flaps.
I applaud Dr. McCauley for assembling this work and making the Galveston experience available to plastic surgeons throughout the world. This is an excellent resource for medical students on surgery rotations who want to learn the basics of burn care, as well as residents and surgeons struggling to design the best operation for these challenging patients. I hope that this book will also inspire some of our trainees to contribute to better methods of restoring these patients to normalcy.
Dennis P. Orgill, M.D., Ph.D.
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Jack A. Friedland, M.D.