Comprehensive Wound Management.

Irion G. Thorofare, NJ 08086, Slack Inc, 2002, paperback, 302 pp, illus, ISBN 1-55642-477-9, $37.

The author's intent is to help the reader develop a systematic approach toward wound care that is based on a thorough understanding of wound formation and wound healing. To achieve this, the text is generally organized using methods described in the first edition of the Guide to Physical Therapist Practice (Guide).

The book is divided into 4 units: "Normal and Abnormal Skin and Wound Physiology," "The Patient," "Characteristics of Wounds," and "Interventions." The chapters within each unit contain objectives, study questions, and references. The text concludes with a color atlas and an appendix with the AHCPR Guidelines for Intervention. There is also an instructor's manual available.

The text is quite readable and designed for easy access to specific topics. In the first unit on skin and wound physiology, the 3 chapters cover the anatomy and physiology of skin and normal and abnormal wound healing. The author uses a conversational writing style that makes this important material easier to read and retain. For example, he describes the macrophage as the "garbage collector" that destroys nonviable tissue and as the "architect" that stimulates new tissue. A glossary, however, would be a valuable addition to this text to help the physical therapist student look up unfamiliar terms more easily.

Unit 2, "The Patient," consists of 3 chapters covering the patient history and tests and measures, physical examination, and nutrition. The chapter on patient history and tests and measures (chapter 4) relates the examination process to the integumentary practice patterns described in the Guide. Relevant laboratory tests and factors such as the social and work history, mobility, and equipment are also discussed. The chapter on physical examination (chapter 5) includes an excellent discussion of vascular tests such as the Ankle-Brachial Index, Venous Filling Time Test, and transcutaneous oxygen measurements. The detailed explanations would be useful for both students and clinicians.

Unit 3, "Characteristics of Wounds," has 5 chapters describing acute wounds, neuropathic ulcers, pressure ulcers, vascular insufficiency, and assessment of wounds. This unit includes causes, assessment, and complications for each wound category. For example, the chapter on neuropathic ulcers (chapter 8) discusses topics such as the differential diagnosis of ulcers caused by neuropathy versus arterial insufficiency, the grading of neuropathic ulcers, and sensory testing of the foot. Interventions for protection and off-loading, including total contact casting, are clearly described and illustrated. The chapter on pressure ulcers (chapter 9) includes an extensive discussion of support surfaces, and the chapter on vascular insufficiency (chapter 10) differentiates between arterial and venous insufficiency and illustrates in detail the application of compression wrapping techniques for venous ulcers.

Unit 4, "Interventions," comprises half of the text. Two chapters on debridement include chemical, autolytic, and sharp debridement as well as mechanical modalities such as hydrotherapy, including pulsatile lavage with suction. One chapter covers electrotherapeutic modalities (including high voltage pulsed current); physical agents including diathermy, ultraviolet C, infrared radiation, and therapeutic ultrasound); negative pressure therapy; hyperbaric oxygen therapy; and larva therapy. For each modality, the indications for use and supporting references from the literature (including textbooks and articles from peer-reviewed journals) are presented. Some of the references are studies that address either the the efficacy of a particular modality or parameters for effective use of that modality. Other references provide guidelines for use of a particular modality that are based on current practice. The chapter on dressings (chapter 15) includes practical details such as the advantages of various types of tapes and the fabrication and use of Montgomery straps. Topical agents, pain management, infection control, and burns are covered in subsequent chapters. The quality of the photographs in the text, however, made it difficult to see some of the details described by the author.

The final 3 chapters discuss developing a plan of care, documentation, and administrative considerations. The information from the preceding units allows the development of a plan of care based on the history and physical examination.

I had 2 deadlines to meet in writing this review--one from the editors of Physical Therapy and the other from staff who have waited to borrow this text! I strongly recommend this book for students and for clinicians who treat patients with wounds.

Elizabeth B Green, PT
Presbyterian Hospital
Charlotte, NC

Ms Green is Rehabilitation Manager in an acute care setting and a skilled nursing facility. Her clinical interests are wound care and geriatrics.