Like other surgical specialties, plastic surgery originated through the efforts of a small group of enthusiasts who, by utilising a particular refine-ment of technique, soon raised the standards of surgical craftsmanship within a narrow field to a high pitch of efficiency. Then came the war, and the techniques primarily evolved for hiding facial blemishes and correcting visible deformities were applied with immense success to the treatment of wounds in general.
Since then, as a natural sequel, plastic surgeons have widened still fur-ther their range of interests, notably in casualty work, in hand injuries and in burns. In doing so, they have implictly ceased to regard themselves as a class apart, exclusive authorities in a chosen field, but rather as expert advisers and helpful collaborators in a wide range of surgery.
Mr, [Ian A.] McGregor is emphatically of this latter class, trained in the Glasgow School of Plastic Surgery, broadened in experience by the responsibility of a busy casualty department, and with a particular interest in the surgery of the hand. His book reflects these interests and this experience, being designed not for special-ists but for all those who are concerned with the healing of wounds.
Its approach is essentially practical, dealing as it does with the choice of incisions, with stitchcraft, avoidance of ugly scars, methods of skin grafting, and similar mat-ters, and with their application to casualty surgery, orthopaedics and general surgery. It will assuredly receive a warm welcome. When the ninth edition was published, it was agreed by the authors that a subsequent edition would again be co-authored and that any further editions would be written by Alan McGregor.
Sadly, this plan was upset by the death on 13 April 1998 of the senior author, Ian McGregor, after a short illness. It is in keeping with his principles and views that this, the tenth edition, remains strictly non-multiauthor in the belief that this approach fosters uniformity of style and opinion. This edition, in common with most previous editions, contains no drastic changes.
Rather, it has seen the consolidation of modifications in practice while continuing to eschew techniques which have yet to be proven of value. The sole exception, which some may feel represents a rad-ical departure, is the deletion of the chapter on maxillofacial injuries.
As the specialty of plastic surgery continues its natural evolution into sepa-rate specialties of reconstructive surgery (with several subspecialties) and cosmetic surgery, it is felt that the time has come to acknowledge that facial orthopaedic trauma has, in most centres, passed into the hands of the oral and maxillo-facial surgeons. For a long time, this chapter has looked awkward and out of place with little obvious relationship to the preceding chapters; consequently, it has been sacrificed to create space for the incorporation of additions without the need for increasing the overall size of the book.
In so doing, the main thrust of the text is altered in a subtle and significant way. It is now concerned solely with the issues which relate to management and repair /reconstruction of defects and wounds by use of skin and other tis-sues. The book could now be titled equally well ‘Fundamental Techniques of Reconstructive Surgery’. Depending on the further evolution of the specialty of plastic surgery, that may yet turn out to be a more appropriate title.
Early editions of this book carried a few ‘clas-sic’ references at the end of each chapter. These were jettisoned in the fifth edition. A review of the ninth edition suggested that these could be reintroduced with benefit.
The decision not to follow this advice has been taken positively. The text represents a distillate of those essential refer-ences blended with the judgement resulting from clinical experience. To paraphrase the late senior author, it ‘cuts out the guff’ and gives the reader what he (or she) really needs to know.
Whatever its inherent weaknesses may have been in the past, this has been the consistent philosophy of the authors and it will remain so in the future. In preparing this edition, ad vice has been taken from colleagues within the specialty, particularly Philip Sykes, Martin Milling and Douglas Murray. The manuscript was prepared by Mrs Colette Derrick, and the entire project was overseen by Deborah Russell and Kim Benson of Harcourt Health Sciences.
The illustra-tions, as always, are by Ian Ramsden. To each of these, thanks are due. Plastic surgical methods are being used increas-ingly often by surgeons who have received no formal training in plastic surgery and who are looking for guidance on the basic techniques.
Advanced textbooks of plastic surgery are apt to pass over those elementary but nonetheless fun-damental methods while the sections on plastic surgery in textbooks of surgery describe its scope and results without giving enough detail of actu-al technique to be of practical use. This book I hope may help to fill the gap.
The first part describes the basic techniques of plastic surgery in detail and the second considers their application to the situations which sur-geons in other specialties are likely to encounter. A difficulty in the second part has been that of deciding what material to include and what to leave out.
The deciding factor generally has been to include such topics and techniques as it was felt a surgeon in the particular field might rea-sonably wish to deal with himself without neces-sarily referring the patient to a plastic surgeon. The book makes no attempt to describe all possible methods of repair and reconstruction.
To include a multiplicity of methods in a book of this nature would merely confuse and I have preferred instead to describe those methods which I have found work best in practice. In discussing the basic techniques I have tried to stress the difficulties of each and to describe the complications, how they can be avoided and how to cope with them when they do occur.
I have endeavoured too, to bring out the principles of the various methods in the hope that an understanding of these principles may weld the technical details into a coherent, ratio-nal pattern and prevent them from being a mere jumble of empirical instructions. A difficult decision has been whether or not to use the eponyms in which plastic surgery abounds.
Eponyms are an essential part of every-day surgical shorthand and they recall men who have stood as signposts along the way of an advancing specialty. But often they lack precise meaning and they are liable to cause confusion, firstly because they sometimes have different meanings in different countries, secondly because they are frequently used loosely so that in some instances a name has even come to be applied to a procedure different from that described by its owner.
The Thiersch graft is an example of this latter category, being nowadays applied to a graft of quite different thickness from that originally described by Thiersch. For these reasons I have regretfully avoided eponyms altogether. References have purposely not been intro- duced into the text. Instead I have listed a few papers and monographs at the end of each chap-ter under suitable subject headings to provide a starting point for anyone wishing to pursue a particular subject further.
I must acknowledge my debt to many who have helped me in preparing this book. To Professor C. F. W. Illingworth who encouraged me at the outset in its writing and Mr J. S. Tough who was responsible for my training in plastic surgery and gave me free access to the photo-graphic records of the Unit I am deeply grateful.
I am greatly in debt of Mr Douglas R. K. Reid for his constructive criticism of the text and for the pains he has taken to make it as lucid as possible without sacrificing brevity in the process. To Professor Roland Barnes and Dr J.C. J. Ives who read and criticised parts of the text I express my thanks.
The illustrations are all-important in a book largely concerned with surgical techniques. Mr Robin Callander made all the drawings and I find it difficult to convey fully the care and trou-ble he has taken to portray visually what I wished to express. Any usefulness which the book may have is due in no small way to his illustrations. The photographs are the work of Mr T. Meikle and Mr R. Macgregor of the Plastic Surgery Units at Ballochmyle Hospital and
Glasgow Royal Infirmary; Mr R. McLean, Department of Medical Illustration, Western Infirmary; Mr P. Kelly, Photographic Department and Mr E. Towler, Department of Surgery, Glasgow Royal Infirmary. For the care and trou-ble which each has taken I am most grateful. I am also indebted to Messrs Chas. F. Thackray for permission to use illustrations of their instru-ments. The typing and retyping of the manuscript was carried out with patience and good humour by Mrs A. M. Drummond.
I should like lastly to record my thanks to Mr Charles Macmillan and Mr James Parker of Messrs E. and S. Livingstone for the advice and help which they have given me throughout.