Skin Care Triad: Continence Management, Wound Care, and Therapeutic Positioning.

Skin Care Triad: Continence Management, Wound Care, and Therapeutic Positioning

Rook JL, Weiss LD, Hagler DD, eds. Woburn, MA 01801, Butterworth-Heinemann Inc, 2000, paperback, 600 pp, illus, ISBN: 0-7506-7035-5, $65.

This book is intended to be used by those who work with patients with continence problems and open wounds. The book is divided into 3 parts: continence management, wound care, and therapeutic positioning. References are listed at the end of each chapter, and there is an appendix listing suppliers of positioning devices.

The chapters on continence management are all written by the section editor (Jack L Rook) and constitute over half the text. The opening chapters on the anatomy of the urinary system and the neurophysiology of micturition lead to a clear understanding of the mechanisms of incontinence. Chapters on imaging, urodynamic studies, EMG and nerve conduction studies, and laboratory studies provide a detailed description of each test or procedure and its relevance. These chapters can serve as a reference about specific imaging procedures.

There is a chapter on each of the 8 types of incontinence, and each chapter includes a description of the problem, components of the history and physical examination, diagnostic studies, and treatment. Treatment options usually consist of containment, skin care, pharmacologic management, and surgical options. Physical therapy interventions such as exercise and electrical stimulation are included for several types of incontinence. This section of the book concludes with a discussion of prostate cancer and related continence issues.

The wound care section has 7 chapters and 7 contributing authors. The chapters on anatomy and physiology, wound classification, and wound healing provide basic information on these topics. The chapter on the etiology of chronic skin wounds addresses a variety of contributing factors such as body loading, infection, malnutrition, immune status, medication, smoking, and radiation. Further discussion of these factors, however, would have been even more useful.

The primary weakness of the wound care section lies in the area where it needs to be strongest: treatment options for chronic wounds. The pressure ulcer chapter has a very limited discussion of treatment options and does not reflect a thorough knowledge of treatments commonly used by wound care specialists. For example, the author states that "local wound care consists of daily cleansing, dressing, and debridement." However, no mention is made of dressings that are changed 2 or 3 times a week. Pulsed lavage is not mentioned as a form of debridement, but options such as scrubbing, dextranomer beads, and hydrotherapy are discussed. Pulsed lavage is a commonly used modality for pressure ulcers because of its benefits such as ease of administration and the prevention of cross-contamination of wounds.

Dressings and topical agents together fill less than a page in the pressure ulcer chapter. There are no specific examples of products, and promising topical agents such as platelet-derived growth factor are included along with honey and yeast extract. A new device, the negative pressure vacuum, is described in as much detail as maggot debridement. These listings will not help professionals who are unfamiliar with many of the products on the market.

Because the etiology of venous ulcers differs from that of pressure ulcers, the chapter on venous ulcers, which follows the chapter on pressure ulcers, does not really fit the concept of this text. There is limited discussion of other compression wraps besides the Unna boot, and the author does not address the need to cover the wound to control drainage and facilitate healing before applying a compression wrap. The need for continued compression of the extremity after the wound has healed is also not addressed.

Fortunately, this section concludes with an excellent chapter on pain management for wounds, which is cowritten by Rook. He again blends anatomy and physiology in discussing the mechanisms of pain and then describes diagnostic and therapeutic options, including alternate therapies. There is an in-depth presentation of pharmacologic options. This chapter provides much detail on a wound topic that is seldom addressed.

The final section on positioning, consisting of a single chapter, is cowritten by a physical therapist. Because positioning is a very individual process, the highlights of this chapter are the examples of positioning options and 2 case studies. There are also some excellent tables, including a quick reference for addressing specific positioning problems and another table that provides positioning options for several diagnoses, such as total hip replacement and hip and knee flexion contractures. However, I would have appreciated more case studies to provide guidance for addressing positioning needs.

The concept of this book is sound. It is critical to consider contributing factors when dealing with patients with fragile skin. It is unfortunate, therefore, that the wound care section does not meet the standard set by the first section. It also appears that the editors of the sections did not thoroughly review the other sections. For example, there are references in the wound care section to other chapters within the same section, but no references to other parts of the book.

Despite these problems, I recommend this book for professionals involved in continence management and wound care because of its global approach to the problems of patients at risk for wounds. The excellent contributions by the lead editor and the resources provided in the positioning section make this a good reference for these topics.

Elizabeth B Green, PT Presbyterian Healthcare Charlotte, NC

Ms Green is Rehabilitation Manager in an acute care hospital and a skilled nursing facility. Her clinical interest is in wound care.