Lymphedema Management: The Comprehensive Guide for Practitioners.

Lymphedema Management: The Comprehensive Guide for Practitioners Zuther JE. New York, NY 10001, Thieme, 2005, hardcover, 270 pp, illus, ISBN: 1-58890-284-6, $69.95.

Zuther has provided a comprehensive, well-written textbook that is clear and concise. The organization is exceptional; each chapter is color-coded for ease in locating or browsing through information, and colored shadings in the text emphasize important points. Numerous clear, color, or black-and-white photographs and line drawings are placed throughout the book. Each chapter ends with a list of recommended readings, and there is a glossary and index at the end of the book.

The text provides an in-depth description of the lymphatic system's anatomy, including the drainage and circulation patterns of lymph fluid. Lymph physiology and lymph pathology are explained, including topics such as chronic venous insufficiency, lipedema, traumatic edema, and lymphedema. The effects of radiation and surgery on the lymphatic system are discussed, along with illustrations of primary and secondary lymphedema. Three quarters of the textbook reviews and examines interventions, such as complete decongestive therapy and manual lymph drainage. Administrative topics, such as reimbursement and billing, are presented in the last chapter, along with non-copyrighted sample forms and templates on issues such as health information consent and privacy rules.

The manual lymphatic drainage techniques described in this text are based on the Vodder techniques. The basic strokes (eg, stationary circles, pump, scoop, and rotary) are described and illustrated. Regional drainage sequences are reported and illustrated in a step-by-step fashion. Extensive bandaging and garment issues also are well described and illustrated. A very clear description of patient self-bandaging, self-drainage, and exercises is provided. The "dos and don'ts" for both upper- and lower-extremity lymphedema are listed. Various bandaging product brands are mentioned, but the author does not recommend specific brands of bandages or compression garments.

The text has a few limitations. The author describes a fairly strict protocol consisting of the Vodder style of manual lymph drainage and does not present other drainage styles and protocols. For example, the use of pump points, "U" strokes, and kinesiotaping are not mentioned. The recommended readings cited in each chapter are limited. A number of points are made with no literature references; however, the majority of references documented are from recent peer-reviewed journals. Some references in the pathology chapter are evidence-based, but, in the discussions about techniques, there are no evidence-based practice references.

In summary, this text provides an excellent description of the lymphatic system and its pathologies and a description of manual lymphatic drainage interventions, including complete decongestive therapy. Regardless of their level of experience in lymphedema management, clinicians who are interested in the Vodder style of intervention will find this book very useful because they can use it in refining their skills and protocols. Clinicians who treat lympedema using an eclectic approach will find this text limited but overall an important book for their library, whereas students and patients interested in this topic will find exceptional value in reading this book. The quality and readability are excellent.

Nicholas F Quarrieg, PT, OCS 

Ithaca College

Ithaca, NY

Mr Quarrier is a Clinical Associate Professor for the Department of Physical Therapy and teaches courses in soft-tissue examination and intervention, and is certified in lymphedema therapy.