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Surgical Anatomy and Technique John E. Skandalakis Panajiotis N. Skandalakis Lee John Skandalakis Surgical Anatomy and Technique A Pocket Manual With 678 Illustrations Springer-Verlag New York Berlin Heidelberg London Paris Tokyo Hong Kong Barcelona Budapest John E. Skandalakis, M.D., Ph.D. The Centers for Surgical Anatomy and Technique Emory University School of Medicine 1462 Clifton Road, N.E. Atlanta, GA 30322 USA Panajiotis N. Skandalakis, M.D. The Centers for Surgical Anatomy and Technique Emory University School of Medicine 1462 Clifton Road, N.E. Atlanta, GA 30322 USA Lee John Skandalakis, M.D. The Centers for Surgical Anatomy and Technique Emory University School of Medicine 1462 Clifton Road, N.E. Atlanta, GA 30322 USA Library of Congress Cataloging-in-Publication Data Skandalakis, John Elias, 1920Surgical anatomy and technique: : a pocket manual I John E. Skandalakis, Panajiotis N. Skandalakis, Lee John Skandalakis. p.em. Includes bibliographical references and index. ISBN-13: 978-0-387-94081-6 e-ISBN-13: 978-1-4684-0203-2 DOl: 10.10071978-1-4684-0203-2 1. Surgery, Operative-Handbooks, manuals, etc. 2. Anatomy, Surgical and topographical- Handbooks, manuals, etc. I. Skandalakis, Panajiotis N. II. Skandalakis, Lee John. III. Title. [DNLM: 1. Surgery, Operative-methods-handbooks. 2. Anatomyhandbooks. WO 39 1994) RD32.S598 1994 617-dc20 DNLM/DLC for Library of Congress 94-17332 CIP Printed on acid-free paper. © 1995 Springer-Verlag New York Inc. All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer-Verlag New York, Inc., 175 Fifth Avenue, New York, NY 10010, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use of general descriptive names, trade names, trademarks, etc., in this publication, even if the former are not especially identified, is not to be taken as a sign that such names, as understood by the Trade Marks and Merchandise Marks Act, may accordingly be used freely by anyone. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Production managed by Laura Carlson and Terry Kornak; manufacturing supervised by Jacqui Ashri. Typeset by Bytheway Typesetting Services, Inc., Norwich, NY. 987654321 ISBN-13: 978-0-387-94081-6 Dedicated to Prof. Gregory Skalkeas with appreciation and gratitude (P.N.S.), with deep respect (L.J.S.), and with brotherly love (J.E.S.). Preface "Reach what you can, my child .... Reach what you cannot!" Nikos Kazantzakis (from Report to Greco, translated from the Greek by P .A. Bien, published by Simon and Schuster, 1965) Surgical Anatomy and Technique: A Pocket Manual: With this title we want to present the stepchild of basic science, "anatomy," and also to emphasize some of the operative techniques of general surgery. We feel that this combination will take students to the promised surgical land. A good knowledge of anatomy will help surgeons avoid anatomical complications, while a masterful technique will allow them to proceed rapidly and securely in the operating room. In my 50 years of teaching and practicing surgery, I have observed that residents, in most cases, come into the operating room without preparation or with a minimum of preparation. When I was a resident, the "Bible" was the atla