Wound Care: A Collaborative Practice Manual for Physical Therapists and Nurses, ed 2.

Sussman C, Bates-Jensen BM, eds. Gaithersburg, MD 20878, Aspen Publishers Inc, 2001, hardcover, 744 pp, illus, ISBN: 0-8342-1973-5, $95.

For physical therapist clinicians and physical therapist students who need a comprehensive resource for wound management, this weighty volume fills the bill. The book's 28 contributors came from the United States, England, and Australia and draw from disciplines such as medicine, surgery, nursing, physical therapy, occupational therapy, pharmacology, orthotics, and nutrition and dietetics to provide a multidisciplinary approach to the topic. The authors cite research to support evidence-based practice and present clinical wisdom for practical advice. Case studies, review questions, examples of assessment tools, charts, algorithms, treatment protocols, and photographs engage readers in the material while demanding clinical reasoning and their active participation in the subject. The book begins with 83 color plates illustrating the phases of wound healing, soft tissue anatomy, the attributes and characteristics of wounds, and disease processes. Some of the plates pertain to case studies in the text, which depict the wound healing that results from specific therapeutic interventions.

The book contains 4 parts: "Introduction to Wound Diagnosis," "Management by Wound Characteristics," "Management by Wound Etiology," and "Management of Wound Healing With Physical Therapy Technologies." The 2 appendixes that conclude the book give readers guidance on using topical antiseptics, antifungals, and antibacterials and provide direction in understanding wound care product categories. The book's organization takes the reader through the same process that expert clinicians use when providing their care.

Part 1, "Introduction to Wound Diagnosis," starts with a chapter on the diagnostic process. The editors of this volume, Sussman and Bates-Jensen, wrote this chapter to take readers through 4 steps of wound management: assessment, diagnosis, goal setting, and intervention. The authors describe functional and behavioral outcome measures and provide 5 assessment forms in the chapter's appendixes to help in documentation. The next 6 chapters provide information for implementing the diagnostic process. These chapters include: "Wound Healing Physiology and Chronic Wound Healing," "Nutritional Assessment and Treatment," "Assessment of the Skin and Wound," "Wound Measurements," "Tools to Measure Wound Healing," and "Vascular Evaluation."

Part 2, "Management by Wound Characteristics," begins with Bates-Jensen's "rules" for wound care: "If the wound is dirty, clean it. If there's leakage, manage it. If there's a hole, fill it. If it's flat, protect it. If it's healed, prevent it [a wound from occurring again]." This philosophical approach forms the basis of the next 6 chapters, which include management strategies for necrotic tissue, exudate and infection, edema, and scar tissue. One chapter discusses dressings and topical agents, and another chapter presents advanced therapeutic interventions, such as growth factors, artificial skin, vacuum-assisted closure, and warm-up therapy. An appendix to the chapter on necrotic tissue management has a 5-page chart that helps clinicians choose the appropriate debridement strategy by wound type and characteristics.

Part 3, "Management by Wound Etiology," contains 7 chapters that focus on the causes of wounds as an approach to comprehensive interventions. This section includes chapters covering topics such as surgical wounds, pressure ulcers, vascular problems, skin infections, foot problems common in older adults, malignancies, and fistulas. A history of staging systems and the current recommended staging systems are presented with the pressure ulcer material, and a whole chapter is devoted to therapeutic positioning. Case studies, self-care teaching guidelines, outcome measures, resources, and review questions are provided in most of these chapters.

Part 4, "Management of Wound Healing With Physical Therapy Technologies," offers 6 chapters that focus on therapeutic interventions. The chapters cover the topics of electrical stimulation, pulsed electromagnetic fields, ultraviolet therapy, therapeutic and diagnostic ultrasound, whirlpool, and pulsatile lavage with suction. The chapters have subheadings titled "Evaluating the Evidence," "Choosing an Intervention: Clinical Reasoning," and "Theory and Science of the Therapy" to provide clinicians with the necessary background required to make informed, reasoned choices for their therapeutic interventions. Case studies provide helpful illustrations of appropriate applications of the selected therapeutic technologies.

Caring for patients with wounds is a daunting task. Often the patients have a number of clinical problems that make assessment difficult. The choice of an appropriate intervention is hampered by the profusion and confusion of changing products and technologies. This well-written, well-organized volume helps students and clinicians meet this challenge and provides a comprehensive approach to wound management. It would be a welcome addition to any professional library.

Jan Bruckner, PT, PhD
Thomas Jefferson University
Philadelphia, Pa

Dr Bruckner is an Associate Professor and Director of Research in the Department of Physical Therapy. She teaches' a course on prostheses and orthoses that has a unit on amputation prevention and wound care. She also runs a foot clinic in Center City Philadelphia for people who are homeless.