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BMJ. 2007 June 16; 334(7606): 1277.
PMCID: PMC1892468
Medical Classics

Extensile exposure

Craig Gerrand, consultant orthopaedic surgeon, Freeman Hospital, Newcastle Upon Tyne

Arnold K Henry was a remarkable man. Born in 1886, he graduated from Trinity College Dublin in 1911 and became fellow of the Royal College of Surgeons of Ireland in 1914. In the first world war he served as a surgeon in both the Serbian and the French armies and was decorated by both. He was accompanied by his wife, Dr Dorothy Milne Henry, who was his close collaborator and assistant. He went on to work as a surgeon in Dublin, then as professor of surgery at the University of Cairo and at the Postgraduate Medical School at Hammersmith, and in 1947 returned to Dublin as professor of anatomy.

In 1927 Henry published a book entitled Exposure of the Long Bones, which was revised first in 1945 to Extensile Exposure Applied to Limb Surgery and then in 1957 as a second edition entitled simply Extensile Exposure. This volume remains an invaluable reference for surgeons of all persuasions, but particularly those who operate on the limbs.

The book covers a lot of ground; from exposures in the neck, the upper extremity, the thorax, the pelvis, and the lower extremity. As the title suggests, the approaches are extensile. For example, the nerves of the brachial plexus can be followed from the neck into the shoulder and the arm. Where other anatomical texts appear dry and uninteresting, Henry's descriptions of the practical aspects of surgical exposure are fascinating and are interspersed with anecdotes from his extensive surgical career. He suggests those not following his advice “will only make a mess.” The “striped (and sometimes flashy)” sandwich of supinator containing the posterior interosseous nerve is “thin, so do not nick the nerve.” The vessels on the deep surface of gluteus maximus sprawl like those of the placenta. Henry is refreshing in his honesty. His description of how his technique for pulmonary embolectomy evolved when operating on three patients is published despite the fact that none survived.

Henry clearly has a sense of humour. He can't resist a dig at other texts, describing the “huge great sciatic nerve” as the one “oasis of description” Gogarty could find in Cunningham's anatomy. The whole is written in a style reflecting a classical education; in Henry's view the hamstring tendons and vastus lateralis are the “Scylla and Charybdis” between which the gluteus maximus may be palpated. His description of the function of gluteus maximus is a particular delight.

There is no doubt that Henry was a man of powerful intellect, with an enquiring and analytical mind. This book contains the distilled experience of many years of practice. It is an apt legacy. Fifty years have not diminished its relevance and usefulness.

Notes

By Arnold K Henry

First published as Exposure of the Long Bones in 1927


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