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Reconstructive Surgery of the Hand and Upper Extremity

Adkinson, Joshua M., M.D.

Plastic and Reconstructive Surgery: May 2019 - Volume 143 - Issue 5 - p 1544
doi: 10.1097/PRS.0000000000005594
Book and Media Reviews

Disclosure:The author has no financial interest to declare in relation to the content of this review.

As a service to our readers, Plastic and Reconstructive Surgery® reviews books, DVDs, practice management software, and electronic media items of educational interest to reconstructive and aesthetic surgeons. All items are copyrighted and available commercially. The Journal actively solicits information in digital format for review.

Reviewers are selected on the basis of relevant interest. Reviews are solely the opinion of the reviewer; they are usually published as submitted, with only copy editing. Plastic and Reconstructive Surgery® does not endorse or recommend any review so published. Send books, DVDs, and any other material for consideration to: Arun K. Gosain, M.D., Review Editor, Plastic and Reconstructive Surgery, Brookriver Executive Center, 8150 Brookriver Drive, Suite S-415, Dallas, Texas 75247.

Arun K. Gosain, M.D.

Review Editor



In the practice of hand and upper extremity surgery, one develops an internal algorithm for treatment based on injury or disease characteristics, patient factors, knowledge of the best available evidence, and personal experience and preferences. The potential types and combination of injuries are innumerable, and proposed optimal treatment will often differ between surgeons. This textbook successfully leverages the collective experience of three leading experts in upper extremity surgery to provide a thoughtful, stepwise approach to nearly all problems faced by the reconstructive hand surgeon. The information included in just over 300 pages of text, clinical images, diagrams, and treatment algorithms is designed to be a user-friendly resource for the resident, fellow, or attending physician looking to develop an evidence-based treatment plan.

Reconstructive Surgery of the Hand and Upper Extremity is divided into seven sections: general principles, techniques of structure repair, treatment algorithms, clinical examples, atlas of flaps, rehabilitation protocols, and classification and zones of injury. The authors provide 115 treatment-specific algorithms divided across 69 chapters. There is also a video describing a thorough patient examination. The end of the textbook provides multiple descriptions of different classification systems and tendon zones of injury that would be invaluable for those first learning the language of hand surgery.

Early in the textbook, the authors emphasize the evolution of reconstructive hand surgery, from one involving multiple staged interventions to the more contemporary approach of early reconstruction of multiple structures to optimize outcomes and shorten recovery. This should not be controversial but unfortunately continues to be so at various institutions. I wholeheartedly agree with the authors’ philosophy of care, as the wait-and-see approach to upper extremity reconstruction is often a disservice to patients and compromises long-term outcomes. A safe yet aggressive approach to hand reconstruction should be pursued, as advocated by the authors.

This textbook is not designed to provide a substantial explanation of all reconstructive problems or surgical techniques involving the upper extremity. There is also no mention of nerve allografts for interposition nerve reconstruction (e.g., nerve autografts and conduits are mentioned multiple times). As such, this is not a standalone resource, and it would be best to pair this textbook with one or multiple other references that provide greater topic-specific detail, especially for those early in training or practice. That said, I particularly enjoyed the unusually detailed focus on postoperative therapy protocols that are less emphasized in surgical training but are supremely important in practice. Nearly one-third of the textbook is dedicated to commonly used flaps in upper extremity reconstruction. The flap descriptions, diagrams, and photographs are excellent teaching tools and will save the surgeon significant time that would otherwise be spent studying multiple different resources.

Although some of the included topics will not necessarily be managed by the plastic and reconstructive hand surgeon, this textbook will be an extremely useful addition to the bookshelf. I congratulate the authors on a refreshing and unorthodox textbook and would recommend this resource to any resident, fellow, or attending physician seeking a straightforward, evidence-based, stepwise plan of care for upper extremity trauma and reconstruction.

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