Surgical Complications: Diagnosis and Treatment by Nadey S. Hakim

By Nadey S. Hakim

As Professor Owen H Wangensteen, one of many maximum educational surgeons of the twentieth century, acknowledged: you're a precise doctor from the instant you can take care of your issues. advised and exact prognosis, in addition to potent remedy, of surgical problems is among the most vital parts of surgical perform. this is often this day extra very important than at the other time, on account that over the past twenty years we have now witnessed the improvement of latest surgical sub-specialties, the acting of complex operations in very difficult sufferers, the advent of latest applied sciences in surgical perform and, final yet now not least, an expanding curiosity in tracking the standard, medico-legal implications, and moral dimensions of surgical perform and malpractice. As surgical issues were offered in short and sporadically in a variety of books and in simple terms as a small a part of chapters facing surgical thoughts, there's a urgent desire for a latest textbook facing the analysis, therapy, auditing, medico-legal implications and moral difficulties relating to surgical problems. Written via the world over recognized authors, the chapters take care of either the overall concerns concerning the surgical problems and the categorical matters regarding each one surgical distinctiveness. each one bankruptcy contains: medical presentation; analysis (clinical, laboratory investigations, imaging); therapy (conservative, surgical); and final result.

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Without such binding, complications will follow, in the form of the depressed or “couched” lens (or “humour”) ascending from the vitreous humour and returning to block out the light. But total immobility of the patient’s head on a specially-devised bed could prevent this from happening. Likewise, bad after-care could lead to an abscess forming, and destroying the patient’s vision altogether. Yet what we find here is that long-familiar resonance going back to Hippocrates: surgical complications are a product of professional incompetence.

For centuries surgeons had had their own chosen “antiseptics”, without any coherent concept of what sepsis was or how it could be prevented, and long-standing favourites had included vinegar, turpentine and wine (or alcohol distilled from wine). Indeed, the great 14th-century French surgeon Guy de Chauliac had recommended “biting wine” or early brandy for such purposes. Yet none of these substances were used in accordance with any proper system quite simply because no one knew how sepsis occurred in the first place, and empirical attempts to mop up “putrefied blood” and then swill out the wound with turpentine or brandy were hit and miss in the extreme.

For”, as John Woodall aptly put it when contemplating a major leg amputation, “it is no small presumption to Dismember the Image of God”. And the relative rarity with which even a surgeon of Woodall’s standing — being senior surgeon at St. Bartholomew’s Hospital, London — exercised that “presumption” is brought home in the 1639 edition of the Surgeon’s Mate. For in this work, Woodall tells us that he had performed a little over 100 amputations in 24 years. On the other hand, his success rate could have been the envy of many senior surgeons of two centuries later, for out of the 100 add amputations, he had only 20 fatalities.

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