Drs. Goldwyn and Cohen have edited a third edition of Dr. Goldwyn's well-known text describing complications and suboptimal outcomes in plastic surgery. This edition, among its many virtues, serves as a crisp illustration of the role of microsurgery in plastic surgery practice.
Dr. Goldwyn's first edition of this book appeared in 1972. Microsurgery does not appear in the index. None of the chapters presents a microsurgical strategy or technique. With an admittedly cursory reading, I could locate only a single mention of microsurgery in the text. In their chapter on nerve injuries of the upper extremity, Drs. Verdan and Narakas stated ``the most accurate suture follows joining fascicle to fascicle with the use of . . . an operating microscope. While this procedure is well known in grafting, we have had only limited experience with it in suturing . . . The results, although the technique is elaborate and difficult, are extremely promising.'' 1 The 2001 edition, in contrast, contains a total of 63 chapters, 12 of which have a substantial microsurgical component.
Dr. MacKinnon contributes a chapter on nerve grafts. She notes that this procedure is based on microsurgical techniques. Her chapter includes discussion of timing of reconstruction, classification of nerve injuries, the role of electrodiagnostic studies, neuroma management, nerve repair and grafting, donor sites, and outcome evaluation. This material provides a framework for dealing with evolving injuries, iatrogenic injuries, and unsuccessful procedures.
Drs. Benacquista and Strauch contribute a general chapter on microsurgery directed principally at flap procedures. Their discussion of management of defects after flap failure is a useful one.