This is a refreshingly original and unusual text. It is a testament to the life work of the author and her struggle to develop clinical microsurgery in Romania. It takes the reader on a journey starting with learning the basic techniques of microsurgery, laboratory and experimental research, teaching and training. It then progresses to the building of an infrastructure for development and clinical practice, the maintenance of meticulous records and the evaluation of results. As such, the book is a very personal account written in an informal style so that the reader can follow the author's own development and experience.
The format is unusual beginning with the author's philosophy for developing reconstructive microsurgery. It then covers personal techniques developed for peripheral nerve repair and microvascular anastomosis. It is clear from early on in this book that the author's main interest lies in the management of peripheral nerves, particularly in limbs. There is a section on reconstructive microsurgery of the brachial plexus following trauma and a section on limb replantation. There is a 20-page section of tabulated information on individual patients showing the type of detailed records that Dr Ionescu maintained.
One of the most interesting chapters of the book is entitled ‘Evaluation of Results According to Reconstruction Objective Groups’. This section, which is over 100 pages in length, includes a series of individual cases posing different clinical problems. It demonstrates the author's philosophy and strategies of treatment planning and shows the results obtained. The numerous illustrations are also unusual as they are in very small format often requiring amagnifying glass to obtain the best results. Much of this section again is concerned with peripheral nerve repair and the results that can be achieved.
The final section of the book headed ‘Conclusions’ lets the reader share the wealth of experience based on over 7500 peripheral nerve repairs and a wide variety of other microsurgical procedures. This, again, is very personal and one can visualise Dr Ionescu teaching younger colleagues and letting them benefit from this wide experience.
The reference section is over 40 pages in length and is not set out in any particular order. This again demonstrates to the reader the author's struggle to learn and develop the necessary skills to provide a first-class clinical service. There is, unfortunately, no cross-referencing in the text, which includes articles, reviews and text books that were clearly influential in the development of this particular surgeon.
This book is atribute to a pioneering surgeon working in a difficult environment at adifficult time. It demonstrates how Dr Ionescu overcame these difficulties and developed an international clinical service. It is not the type of book that surgeons might take up and read or use as a reference text. It is certainly a book that those who know this particular surgeon will enjoy reading. The conclusion section and some of the clinical cases that identify her thought processes and her experience are certainly worth reading and could prove very helpful to surgeons both young and old.