Leg Ulcers: Diagnosis and Management (3rd edn)

Abstract

The title, Leg Ulcers: Diagnosis and Management, gives the impression that this text book has been restricted to the subject of leg ulcers. However, one soon discovers that it is a comprehensive text book of lower limb venous diseases. Leg ulcers, particularly those of venous aetiology, constitute a major health problem in most Western countries. A significant proportion of the venous leg ulcer patients are relatively young, resulting in economic losses not only from the cost of treatment but also from the wastage of productive man-hours. As highlighted in the text book, the principal health personnel who manage venous leg ulcers vary between countries. In the UK, for example, the majority are initially seen and managed by nurses in community leg ulcer centres. This, notwithstanding the high profile given to venous diseases in general and leg ulcers in particular by the editors, is highly commendable since for most vascular units venous disease would contribute to at least 30% of their workload. A detailed examination of normal anatomy and physiology of lower limb veins and a thorough discussion of pathology, pathological anatomy, pathophysiology, epidemiology and clinical presentation of all aspects of lower limb venous diseases have been systematically reviewed. Venous leg ulcers have been didactically presented with the specialist in mind. Extensive discussion of conventional and the more controversial views on pathophysiology have been appropriately discussed in a balanced format without the authors' personal bias influencing the quality of materials presented. The basis for the accepted methods of investigation and treatment of venous leg ulcers, including compression, therapy and surgery are well presented. Unproven methods of treatment like pharmacotherapy, topical treatment and more modern methods including foam sclerotherapy, echosclerotherapy and endovenous laser treatment have also been adequately covered. There is also a very good chapter on ‘The Differential Diagnosis of Leg Ulcers’. The text is illustrated using excellent line diagrams, black-and-white as well as colour photographs. Each chapter has been very well researched with a comprehensive list of references. Perhaps my only criticisms of the text book are the several instances of repetition and a few typographical errors. On the whole, however, it is a good specialist text book of lower limb venous diseases which any vascular surgeon with a special interest in this field would find quite useful.