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Surgery .0£ the Thumb. By D. A. Campbell Reid and D. A. Mc­Grouther. Stoneham, MA, Butter­worths Publishers, Inc., 1986. 236 pp. $135.00.

The hand therapist is constantly called on to treat patients following complex reconstructive surgery. This means we need to understand both the procedures and their indications in or­der to effectively evaluate and plan treatment. Thus, we find ourselves at­tending many conferences and read­ing piles of surgical journals and texts. We rely heavily on standard references such as Green's Operative Hand Surgery, to which we can turn when a patient appears on the doorstep with an un· familiar diagnosis.

In my current practice I see many patients following thumb reconstruc­tion and therefore chose this book to review, in the hope it would prove to be just such a handy reference. My hopes were realized. In fact, I found the book's emphasis on function, its recognition of the therapist'S role, and its succinct prose to be refreshing bo­nuses.

The authors open with a·short but intriguing chapter on the historical and functional importance of the thumb in the hand. The following chapter dis­cusses anatomy and function of the thumb, illuminating clearly its com­plexity. The remaining chapters are devoted to various types of injury or disability, and specific surgical inter­ventions. These chapters cover, re­spectively, open injuries, closed inju­ries, replantation, post-traumatic reconstruction, thumb web contrac­tion, paralytic conditions (of both pe­ripheral and central nervous system origin), arthritis, congenital anoma­lies, Dupuytren's disease, stenosing tendovaginitis (using the British ter­minology), burns, and tumors.

It should be noted that a novice therapist might find some of the dis­cussions more bewildering than help­fuL as the authors take for granted un­derstanding of basic plastic and orthopediC surgical techniques. For ex­ample, they refer to particular flaps such as the V -Y advancement flap with no explanation or definition given. On

the other hand, the book does describe some techniques that surgeons consid­er "givens," such as means of testing the viability of skin flaps.

The therapist's role is inconsis­tently recognized in the book. The au­thors are to be applauded for empha­sizing the importance of therapy in some instances, and for at least sum­marizing postoperative therapy and splinting in others. Having gone this far, though, it would be gratifying to see them recognize other possible con­tributions by the therapist. For exam­ple, they recommend splinting to cor­rector prevent thumb web space contracture but say nothing of splint­ing to prevent deformity in the pe­ripheral nerve-injured patient await­ing nerve return or surgery. They strongly advocate joint protection ed­ucation, night splinting, and conser­vative therapy in acute stages of rheu­matoid arthritis, and consider "critical" a therapist's functional assessment in preoperative planning for rheumatoid patients. However, they completely ig­nore the role of the therapist in the care of the osteoarthritic thumb.

This shortcoming is more than outweighed by the book's strong points. Particularly impressive are the clear discussions of principles behind surgical planning, stressing such as­pects as CMC mobility or stabilization in functional opposition, the impor­tance of sensibility, and the thumb length necessary for effective opposi­tion. Surgical procedures are ex­plained concisely, with helpful illus­trations. The pros and cons of various approaches are weighed objectively, and the book provides a wealth of background information as an aid to understanding indications for surgery.

Immediately after acquiring Sur­gery of the Thumb, I began to use it as a reference, and having read it I now understand more precisely some of the subtleties of the planning involved in several of my patients' thumb recon­structions. It is well worth the pur­chase price for any hand therapist seeking such a specialized surgical ref­erence.

Karen Stewart MS, OTR

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