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Top Knife: The Art and Craft of Trauma Surgery Review

Top Knife Book coverA BAPS Book review by Mark Davenport

Asher Hirschberg and Kenneth L Mattox

2005 TFM publishing Ltd.

£26.99 Amazon


This is a book doing the rounds with the impressionable, excitable and youthful members of BAPS, so I thought I’d see what all the fuss was about.  With chapter titles like “The Injured Liver: Ninja Master” and “Big Red & Big Blue: Abdominal Vascular Trauma” what’s not to like?

The title alludes to Tom Cruise and “Top Gun” (a classic film from 1986) of course though probably without the Kelly McGillis love interest or his iconic Kawasaki Ninja motorcycle.  So what can two professors of trauma surgery in Brooklyn, New York and Houston, Texas tell the “residents” of downtown Tooting, SW17 or the shining citadel of trauma in Whitechapel, E1?  I appreciate both places do seem to be overrun by penetrating knife wounds at the moment but damage from a good old AR-15 still seems a remote possibility.

The authors adopt a GREAT style with lots of EMPHASIS on key points to stick in the memory. Is it a “small problem or BIG TROUBLE”? There are lots of really good schematic line-drawings to aid understanding and absolutely no blood-soaked colour photographs which don’t.  Each chapter comes with a tips and tricks list at the end to commit to memory.  The 15 chapters cover the compendium of trauma surgery for the general surgeon with the accent on damage control, and quick fixes and not so much on esoteric textbook solutions where there are more descriptions than actual survivors (e.g. the atriocaval  shunt). The titles range from “Stop that Bleeding!” through “The Wounded Surgical Soul” to “The Neck: Safari in Tiger Country” which conveys some of the stylistic prose and are always fascinating to read. One can’t fault their approach to the trauma laparotomy starting with “Hey diddle, diddle, right down the middle” and then “you’re in the belly ready to Rock and Roll…” and my favourite counter to what to do with a smashed-up spleen – “one very effective technique of splenic preservation is the formalin jar”.

Some of their phrases do stick in the mind, as they are of course supposed to.  “The spleen, kidney and distal pancreas are the take-outable organs” and “Don’t forget the internal mammary artery because it won’t forget you” if you actually get as far as closing a living patient following your clam-shell thoracotomy.  I also reacquainted myself with the names attached to the retroperitoneal incisions used to mobilise the viscera on the left (Mattox – one the authors here) and the right (Cattell-Braasch) and learned about the emergency 1800 twist you can do in order to control extreme lung bleeding – having remember to divide the inferior pulmonary ligament of course.

I suppose we are in the current era of the least experienced paediatric surgical trainees in living memory (take a bow – the European Working Time Directive). Nowadays, most of our training centres do have a very limited exposure to trauma either because of outsourcing it to the Major Trauma Centres and their roaming bands of professional “trauma surgeons” and the expectation of finding yourself in such situations is probably remote. But you never know, and in my experience even the most hardened trauma exponent will be put off by the youngster caught up as an innocent bystander in a South London turf war and will defer to your judgment. This book will provide you with at least a wealth of practical knowledge from surgeons at the very sharp end.

It is a great book and certainly a recommendation to all those paediatric surgeons who run towards the sound of gunfire…as the authors tellingly say: “Good Judgment comes from experience; experience comes from Poor Judgment….”

Prof Mark Davenport

King’s College Hospital,


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