Book Reviews
Reconstructive Surgery & Rehabilitation in Leprosy and other Neuropathies. Richard Schwarz, and Wim Brandsma. ISBN 99933-1-371-8. EKTA, Kathmandu, Nepal GBP 20, 2004
This 388-page multi-authored paperback focuses on aspects of surgical reconstruction and rehabilitation for impairments in leprosy and complications in diabetic feet. The editors, one a surgeon and the other a leprosy physiotherapist, have dedicated the book to the late Dr. Paul Brand who pioneered reconstructive surgery in leprosy at the Christian Medical College Hospital, Vellore, India, and who, with extraordinary foresight, concurrently introduced rehabilitation of the leprosy disabled at a "New Life Centre" within the hospital for channelling the skills of the affected individuals to safer vocations to prevent damage of their hands and feet. The Centre came to be recognized as "the birthplace of hand rehabilitation."
The text has a wide variation in style and emphasis between chapters, which is to be expected in a book with authors of varied experience. Chapters elaborating general principles of reconstructive surgery, functional assessment, and motor and sensory assessments are well written and contain a lot of new details in the respective areas. Quick referencing would have been much easier had such useful information been placed under suitable subheadings.
A book which title ends with "other neuropathies" ideally requires a Neurologist and/or Neurophysiologist as a co-author to elaborate several neuropathies that have features akin to leprosy in order to have greater appeal in countries were leprosy is uncommon. Terms like (a)sensate and (re)occurrence rather than the accepted "insensate" and "recurrence," respectively, are ambiguous in describing clinical states and can make for imprecise field level reporting. The chapter on Neuritis is projected well with emphasis that steroids by itself are more beneficial for early nerve impairment. I think there were grounds for stressing the need for controlled studies of fascicular nerve decompression under magnification alongside steroid therapy in early neuritis for providing a more significant sensory recovery and indeed motor improvement, since loupes and operating microscopes are used in several large centers in the developing world.
The chapters covering surgical reconstruction in the hands, feet, face, and nose are comprehensive with most segments of these texts re-emphasizing the foundation procedures, a testimony in itself to what most of these work-horse reconstructive surgeries had adequately accomplished over the past five decades. Tension adjustment techniques for tendon transfers in the hand do not include a discussion on the newer proposals to measure intraoperative sarcomere length with laser diffraction technique that also combine information on biomechanical modelling generated from normative values of the muscle architecture, tendon compliance, and joint moment in order to optimize function of transferred tendons.
The chapters on Neuropathic feet, and Management of Ulcers in the Neurologically impaired feet are chapters that stand alone, providing a welcome trend in evolving strategies for treating persistent secondary impairments of the feet. There is greater clarity on salvage procedures of Neuropathic feet and this taken together with Appendices C, D, and E makes for an excellent source of reference in managing difficult complications in leprosy and diabetic feet.
The chapter on pre- and post-operative therapy techniques already well established by physiotherapists of the past genre is revisited adequately. The chapters on Orthotics and Prosthetics, and Rehabilitation are concise and clear. The figures in the text are acceptable for the paper they have been printed on. The caveat in the line illustrations is for surgeons in training and those just starting out to realize that these are intended to conceptualize the procedure rather than provide precise technical details for obtaining the best results.
There are few typographic and syntactical errors, and wrong referencing. Other deficiencies are the absence of a chapter on operating theater techniques to aid leprosy centers; the absence of a listing and illustration of common assortments of instruments for tendon transfer surgery, bone surgery, and some special instrumentation for arthrodesis, skin grafting, and flap cover; and the absence of evaluation/grading systems to study the results of various surgeries so that young surgeons can learn from large centers, compare outcomes and improve on techniques. Contradictory remarks on internationally accepted surgical procedures are placed as editorial inserts in few areas of the text. However these deficiencies should not be considered as limiting in the importance of this book which the editors present in a 2 columns per page format at the affordable price of GBP 20.
At a time when molecular biologists are assiduously mining Mycobacterium leprae genome in search for better diagnostics and vaccines, and sero-epidemiologists newly research the prevention of leprosy, more ground is being covered by social and behavioral scientists to influence the course of the disease and its total control, and deformity rates are plummeting below 2 per thousand from the 20 per thousand it once was on record, the editors are to be congratulated for updating a text on reconstructive surgery for residual deformities in leprosy. This book should be in hospital libraries alongside the well known classics in leprosy reconstruction and rehabilitation so as to benefit special interest groups like young surgeons and trainees in orthopaedics, plastic and general surgery, and leprosy therapists attached to hospitals dedicated to the care of leprosy patient and the diabetic.
- Dr. George A. Anderson, M.S. Orth.,
D. Orth., MNAMS, M.Ch. Orth.,
FAMS, FACS
Professor of Orthopaedic Surgery & Head:
Dr Paul Brand Hand Surgery & Leprosy Reconstructive Surgery Centre
Christian Medical College Hospital,Vellore 632004, Tamil Nadu, India
E-mail: andersongeorge@hotmail.com, G.A_Anderson@cmcvellore.ac.in
Reconstructive Surgery & Rehabilitation in Leprosy and other Neuropathies.
Reconstructive Surgery & Rehabilitation in Leprosy and other Neuropathies, edited by Schwartz and Brandsma, is a twenty-four chapter, three-hundred and eighty page text which provides a review of surgical and therapeutic modalities for the health-care providers treating leprosy. The editors are diverse in their discipline, one a surgeon and the other a physiotherapist. The editors authored some of the chapters, but solicited eighteen other professional contributors with international experience to author the majority of the chapters. Although the book is not totally comprehensive for every surgical technique or modality available, it is broad-based concerning leprosy care.
The information in each chapter is presented clearly. The material is well illustrated, including both drawings and photographs to assist the reader in understanding the surgical techniques or concept of treatment. The appendices provide sample assessment protocols as well as a section concerning casting techniques.
The book was dedicated to the memory of Dr. Paul Brand. Dr. Paul Brand was a researcher, surgeon who developed surgical techniques, and rehabilitation physician who treated patients in an holistic manner. By combining all these gifts, Dr. Brand directly treated thousands of patients with disabilities caused by leprosy. More so than his direct treatment of leprosy patients, Dr. Brand understood the importance of training other individuals in the care of leprosy patients and sharing the information that acquired concerning this treatment. Dr. Brand devoted most of his life to this mission of teaching therapist and surgeons. Schwartz and Brandsma need to be congratulated in continuing Dr. Brand's mission by providing an excellent resource for health-care providers involved in the care of leprosy patients
-Dr. Ronnie Mathews
Orthopedic Consultant
National Hansen's Disease Programs