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Doody's Review ServiceReviewer: Gale Lynn Tang, MD (VA Puget Sound Health Care System)
Description: This concise book describes the pathophysiology, diagnosis, and current treatment strategies for lower extremity venous ulcers.
Purpose: The book aims to outline the pathogenesis and current treatment strategies for venous ulcers. Given the recent explosion of endovenous techniques and the high prevalence and morbidity of venous ulcers, the book is well timed and does an excellent job of meeting the objectives.
Audience: It is written primarily for practitioners who see venous wounds — particularly those in vascular surgery, plastic surgery, and nursing. It is very succinct and readable. The senior editor has published widely in the field and is a recognized expert on venous disease.
Features: The first of the four sections covers the pathophysiology, molecular mechanisms, epidemiology, and diagnosis of venous disease. The second section covers conservative management of venous ulcers, while the third section covers operative interventions. The fourth section of special topics covers advanced limb salvage with wound vacuum assisted closure (VAC) therapy, free flaps for coverage of recalcitrant ulcers, revascularization for arterial insufficiency, and endovenous recanalization of the deep venous system. Foam sclerotherapy is covered exhaustively and somewhat redundantly. The techniques for creating and injecting foam for sclerotherapy are described in sufficient step-by-step detail that someone new to the technique could probably carry it out. Radio frequency ablation (RFA) and endovenous laser ablation (EVLA) are also described, but in less detail. There are two chapters devoted to the wound VAC system, which are somewhat redundant. The book does assume some prior knowledge of venous disease; the CEAP system of classification is widely used, but the acronym is never fully defined (C - Clinical, E - Etiology, A - Anatomy. P - Pathophysiology).
Assessment: This is a concise guide to diagnosis and therapy of the very common problem of venous ulcers. The book does a great job of summarizing current treatment strategies, both for local wound care as well as for treatment of the underlying venous hypertension.