Book review
Srinivasan, H. and Palande, D. D. Essential Surgery in Leprosy; Techniques for District Hospitals. Geneva: World Health Organization, 1997. Softbound, 136 pages, black and white illustrations. Order from: World Health Organization, 1211 Geneva 27, Switzerland.
Essential Surgery in Leprosy; Techniques for District Hospitals is a handbook published by the World Health Organization (WHO) intended for surgeons. The text is divided into two parts. The intent of the first part is to acquaint surgeons with conditions unique to leprosy patients and the surgical management of these conditions in general hospitals. The second part describes correction of paralytic hand which requires more specialized care on the surgical level as well as supportive therapy requirements.
Chapters 1 and 2 provide an overview of the surgical procedures in leprosy patients. Chapters 3 and 4 provide a very thorough discussion of surgical procedures to promote healing or prevent recurrent plantar ulceration of feet. Included is a discussion of treatment of plantar ulcers with plaster of paris cast. In addition to the description of the surgical procedures, anesthesia and postoperative care are also included. Chapter 5 provides the surgeon information for management of infections of the hand, including discussion of pertinent anatomy of the hand. Chapter 6 describes various procedures for decompression of inflamed nerves, including the indications for this type of surgery. Patients should be under treatment for the underlying disease prior to nerve decompression. Tarsorrhaphy as an emergency procedure to prevent corneal ulceration is described in Chapter 7. Cosmetic reduction of megalobule of external ear is discussed in Chapter 8. Chapter 9 deals with surgery for the correction of foot drop, including techniques of tibialis posterior transfer, lengthening of tendon Achilles, and transfer of peroneus longus.
Chapters 10, 11, 12, and 13 are included in part two. They include procedures designed to restore function to the deformed hand, fingers, and thumb. The authors state that this part of the book is not for many district hospitals. They limit their discussion to a few procedures which, in their opinion, have minimum demands. They describe indications for the few procedures which they included in the text. However, many other established procedures with specific indications are not included.
Overall, this book will assist surgeons in providing basic surgical care of leprosy patients in the general hospitals, but it is inevitable that more specialized care should be provided by specialized institutions. Reference is made throughout the text of the book to conditions that should be referred to surgeons with special training or expertise.
The book is well illustrated, with diagrams showing techniques. The text is clear and easy to read. The book can be recommended for any clinician treating leprosy patients.
- Ronnie Mathews, M.D.