|Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
The second half of the twentieth century has brought new dimensions to plastic surgery. The premonitions were there before 1912, when the French surgeon Alexis Carrel was awarded the Nobel prize in medicine and physiology for his work with vascular anastomosis. He performed successful autotransplants of kidneys and extremities as well as the whole scalp and ear of dogs by suturing together relatively large arteries and veins. His subsequent ventures with C.C. Guthrie into heterotransplantation failed and, as Harry Buncke has written, "interest in their work died with their transplants." But the idea of tissue transplantation had been born and Carrel was its father.
This fertile field lay fallow for an inexplicably long time. In the late 1950s, there was a revival of interest in experimental small vessel anastomosis in the laboratory. Then, suddenly, in the late 1960s, one of plastic surgery's frontiers began to bulge as microsurgical replantation and transplantation became clinical realities.
The author of the monumental book you are reading is one of the small cadre of pioneers who changed the dimensions of plastic surgery. The book is monumental, I think, in both senses of the word. It is certainly "enormous, larger than lifesize." It is also "an outstanding and enduring achievement viewed as a model for later generations." I have no doubt that, long after Harry Buncke and you and I and all the contributors to this book have gone on to whatever reward awaits us, this book will endure, carefully preserved on the shelves of collections along with other "cornerstones" of medical history by Cushing, Kazanjian, Osler, Potts, Harvey, and others.
More than 30 years ago, Harry Buncke began trying to sew together the 1 mm blood vessels in rabbit ears, funded by a generous yearly grant of $500, and without the luxury of a microscope. The results were not encouraging, but he persisted. He eventually acquired an operating microscope.
At the time, he was working with vessels smaller than others in the field. He lost his grant and no other could be obtained. He spent his free time at home unwinding silk from cocoons and trying to metallize the ends as needles. Eventually, engineers from Silicon Valley helped him to develop suitable sutures and instruments. He did not give up. His will to make microsurgery practical was as strong and as old-fashioned as the ancient New England hickory skis he insisted on using long after everyone else was skiing on laminates and plastic. His fourth successful toe-to-thumb transplant was performed on a monkey in the back bedroom of his home with his dermatologist wife, Constance, assisting. One of the Bunckes' sons, Geoffrey, then 8, invited his music teacher to
After his first experimental successes, Harry was invited to teach. Constance remembers him at a plastic surgery meeting in Las Vegas, tenderly caring for 20 rats in the family RV in the hotel parking lot until time came for the instructional course. These primeval endeavors led eventually to the development of the Microsurgical Unit at the Davies Medical Center in San Francisco, where hundreds of microsurgeons have been trained and thousands of replants and transplants have been performed. The collective experience of that busy unit is here in this book, as well as that of other experts in the field.
There is everything in this book for the novice and something for the most experienced. It is an eminently pragmatic book, but it does not lack a convincing "surgical philosophy," if that is not an oxymoron. It is a book meant for heavy practical use. It will tend to get dog-eared and coffee-stained. Take good care of it. Remember that you are going to leave it to your grandchildren for their collections.
JOHN M. GOIN, M.D.