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Arun K. Gosain, M.D.
Lymphedema: Complete Medical and Surgical Management, edited by Neligan, Masia, and Piller, lives up to its title of completeness. In an era where the value of publishing hardcopy textbooks is questionable, the editors clearly worked closely with CRC Press to maximize the value of a tangible text. As such, the book is a worthwhile investment for the practicing physician who manages patients with lymphedema.
Forty-eight chapters begin with a “current concepts” overview, transition to anatomy and physiology, then explore diagnosis and treatment in the latter two-thirds of the textbook. Part 1 of the text is brief, but hardly seems necessary, as all of the concepts are repeated at the beginning of most of the clinical chapters. Part 2 is dedicated to anatomy, physiology, and lymphangiogenesis. These are expectantly dry, and the level of detail presented, although impressive, likely appeals to a very narrow subset of clinicians. Part 3 details pathophysiology and clinical presentation. General concepts around primary and secondary lymphedema are reviewed by various authors; however, these are almost all repeated again throughout part 5, which focuses on current treatment of lymphedema. Part 4 of the book, Diagnosis of Lymphedema, was informative throughout nine chapters that each describes a method for following the disease.
The meat of the book for the surgeon is part 5, which is accompanied by a DVD containing video clips to eight of the 17 chapters. I found this to be the most valuable part of the book, and by providing these videos, the text overcomes the inherent redundancy that plagues most textbooks. I think there is a tremendous usefulness to observing different practicing surgeons performing similar techniques. A shortcoming of the video section is that not all videos are accompanied by long-term follow-up.
Key points and clinical pearls are provided at the beginning and end of most chapters, respectively. These certainly help focus the reader’s attention and provide insight into whether you will find what you are looking for in that particular chapter.
In particular, I found the persistent emphasis many authors place on the importance of preoperative assessment to be telling. Choosing who to operate on and which type of lymphedema procedure to perform is the most basic yet most challenging aspect of this field. I appreciated gaining a better understanding of the differences between indocyanine green lymphography (usually the first preoperative test chosen), magnetic resonance lymphography (chosen for three-dimensional reconstruction of the entire limb and to demonstrate deep and superficial lymphatic systems), and computed tomographic angiography (usually reserved for planning of axillary lymph node transfer). Also of note, Drs. Dayan and Smith detailed the concept of reverse lymphatic mapping to minimize the risk of donor-site lymphedema in vascularized lymph node transfer that is well-explained and easy to adopt when planning these operations.
Given the detail of the chapters and the accompanying DVD, I can see residents referring to this book when preparing presentations; operating surgeons as well will find pearls within the management chapters useful to their clinical practice. Lymphedema: Complete Medical and Surgical Management deserves a place on the bookshelf if this field is part of your training program or clinical practice.