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Indian Journal of Plastic Surgery
Medknow Publications on behalf of Indian Journal of Plastic Surgery
ISSN: 0970-0358 EISSN: 1998-376x
Vol. 43, Num. 1, 2010, pp. 121-122

Indian Journal of Plastic Surgery, Vol. 43, No. 1, January-June, 2010, pp. 121-122

Book Review

Practical Plastic and Reconstructive Surgery

Editor, Indian Journal of Plastic Surgery

Correspondence Address: Editor, Indian Journal of Plastic Surgery

Code Number: pl10035

Naven Olivari
Edition 2009
Kaden Publishers, Heidelberg, Germany
No. of pages: 943

'Practical Plastic and Reconstructive Surgery', authored solely by Prof. Neven Olivari of Germany, is a truly unique book of Plastic Surgery, which totally lives up to its name! Yes, if I have to describe it in one word, it is downright 'practical'. Insisting that the best solution for any surgical problem, is the one which is simple, easily reproducible, low risk, and offers best functional and aesthetic results, the author very candidly states that he is very skeptical of literature that has beautiful drawings, but no evidence of clinical use; and then he goes on to present this masterpiece!

This book is an atlas of operations and techniques and has glowing forewords from a present and a past luminary of Mayo Clinic, Rochester, Minnesota, Philip G. Arnold and Ian T. Jackson. Divided in seven sections, each better than the previous one, the learned Professor has poured all his surgical lifetime knowledge to create a magical experience for his readers.

With minimum use of words, every section comprises a series of problems - their operative plan in the form of line diagrams and a set of pre-operative, post-operative and long term follow up photographs. The line diagrams are all drawn by the author himself in multi colours and different shades for easy understanding. These clear and descriptive hand drawn illustrations with prominent labeling and simple to follow legends form the hallmark of this book.

Section I is on 'History of Plastic Surgery' in which the author has started the journey from the life and time of Sushrutha and then gone ahead to describe the history of suture techniques and surgical instruments. The history of a few common Plastic Surgery operations like those for Cleft Lip, reconstruction of lip defects, local flaps on the face and reconstruction of nose are discussed in vivid details in this section.

Section II is on 'General Principles' in which the author offers a classification of flaps and illustrates commonly used random pattern, axial pattern, myocutaneous, fasciocutaneous and free flaps. There are also lucid descriptions of Tissue expansion, Wolfe grafts and composite grafts in this section. Practical tips to correctly fix the Wolfe graft on the nasal tip and dorsum, or use a composite auricular cartilage for alar defects are remarkable; and words of caution like "Post operative cooling of the composite graft for 24 hours" and "a blue graft is a good sign and a white graft is a suspect" are instantly eye catching. Bone grafting and management of soft tissue trauma also are wonderfully illustrated in this section

Section III is on 'Head and Neck', and this is my favorite part of this book. Suggesting with absolute clarity how to cover defects in the nasal area, eyelid region, lips, rest of the cervico-facial region and the hair bearing scalp, this is the section where the author describes the surgical treatment of endocrine ophthalmopathy, an area, the author has long been renowned for. In this section, the author introduces to his readers unique instruments like the Olivari Rhinostome, which he uses for lateral osteotomy in his rhinoplasties, and which he claims, is less traumatic than the saw and more precise than the chisel.

Every deformed nose is depicted by a line diagram of the morbid anatomy of its skeleton before surgery and what was done during surgery and finally the anatomy of the corrected skeletal framework. Pre, per and post-operative photographs accompany these diagrams to make is very interesting to read. Words of caution for the reader are in abundance - cautioning against people with very unreasonable expectations from face lift, the author says "the face may be lifted, but the human being as a whole is not rejuvenated". He is also a bitter critic of suboptimal surgery and does not spare surgeons "who choose a 5-cm pre-auricular incision and who have the nerve to publicize this at congresses and on television as mini lift".

This section also has 'Cleft Lip, Jaw and Palate' and the author shows a clear preference to Tennyson repair with a small extra triangle a-la-Skoog, at the nostril floor. His coverage of alveolus with buccal flap instead of gingival tissue is however not destined to allow eruption of teeth through it. Facial nerve pareses and repair of ear and conchal defects also find a place in this section.

Section IV depicts 'Chest and Chest Wall' and in this the author describes post mastectomy breast reconstruction in great details. Use of implants, pedicled Latissimus dorsi, pedicled TRAM, free TRAM, turbo TRAM and free gluteus maximus - their indications, contra-indications, planning, surgical technique and complications are described in vivid details. Correction of inverted nipple by author's own technique, treatment of hydradenitis suppurativa and use of free tissue transfer for massive chest wall and axillary defects also find a mention in this section.

Section V consists of 'Abdomen, gluteal region and genitelia' and in this the author has tackled the problem of large abdominal hernias and highlighted the use of Prolene mesh and Ramirez procedure. The treatment of obesity - liposuction, abdominoplasty and body lift are also mentioned in this section as are the treatment of pressure sores, pilonidal sinus, penile contractures, perineal defects and epispadias.

Section VI is based on 'Skin and soft tissue defects in the extremities' and in this the author talks about various types of flaps used in limb reconstruction. He also discusses 'amniotic band syndrome' in great details, dividing it into grades I to V defining surgery for each grade. The highlight of this section however is his 'Principles of replantation surgery', in which, he lucidly elucidates the pre-operative treatment of the amputated part, indications of replantation, types of amputation, pre operative planning, surgery, post operative monitoring and possible complications.

Section VII is on 'Surgical therapy of burn injuries' which not only comprises detailed synopsis of the pathophysiology of burn, but also portrays a classification of burn trauma and detailed treatment options of both generalized body surface and specialized areas like the hand.

The fact that Prof. Naven Olivari has not only authored the book, but has also drawn each and every illustration obviates any possible communication gap between the author and his artist/illustrator. Published originally in German, the book is now available in English for the benefit of a larger audience, which it surely deserves. The 943 page, hard bound single volume book has been published by Kaden Publishers of Heidelberg, Germany. This is a book which is a must for every Plastic Surgery library for the author's passion and brilliance and the book's simplicity and clarity.

Copyright 2010 - Indian Journal of Plastic Surgery

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