April 2005 • Vol. 1, No. 1
	Advancing Orthotic and Prosthetic Care Through Knowledge

Book Review

Atlas of Amputations and Limb Deficiencies: Surgical, Prosthetic, and Rehabilitation Principles, Third Edition

The orthotic and prosthetic profession has been steadily improving and increasingly documenting what is state-of-the-art care. For 2005, we have an updated cornerstone in our efforts to enhance our practice of prosthetics and the critical role we, as prosthetists, play in the everyday lives of amputees. The third edition of the Atlas of Amputations and Limb Deficiencies has been published and is set for release.

The Atlas, last released in 1992, has committed to the written page some of the best information one can find on the topic of amputations and the plethora of collateral subjects that must be learned if one is to practice as a prosthetist. The editors-in-chief, along with the other personnel who put together such a text, have done an excellent job in expanding the relevant topics without excessive chapters of minutiae. Even though each chapter is well-crafted and interesting on its own, the compilation generates several themes that the editors evidently thought invaluable to anyone improving his or her baseline knowledge of the topic. What struck me is the manner in which the editors blended each chapter, and by extension the entire tome, to read as if written by one author.

The Atlas of Amputations and Limb Deficiencies is available through the Academy Bookstore online or at (301) 617-7805.

The Atlas reinforces the traditional rehabilitation goals for amputees but adds new gravity, importance, and objective data to that message. The success of any future patient still weighs heavily on the skill of the surgeon and the techniques employed to either salvage the limb or amputate. Involving as many as possible of the other medical professionals in the pre-surgical planning and postoperative care will undoubtedly improve the rehabilitation outcomes over time. Amputation surgery must be viewed perceptually and functionally as reconstruction of the limb, not ablation. Dr. Ernest Burgess was a constant proponent of this viewpoint and was given homage by Douglas G. Smith, MD, in the second chapter, "General Principles of Amputation Surgery."

The first seven chapters of the Atlas provide very detailed and updated information on surgical principles. In particular, the chapter on "Trauma: Limb Salvage vs. Amputation" by Michael T. Archdeacon, MD, discusses in depth some of the different indices used to score limb viability to determine whether to salvage or amputate. He reports that the indices alone are not reliable indicators with respect to long-term success, quality of life, and rehabilitation. The surgeon must take into account what is technically possible versus what will be the best long-term treatment in limiting pain and suffering. Even with the many new techniques available to surgeons, they once again face the same dilemmas as in years past. Do I put a patient through four, five, or six surgeries just to end up at the same point of amputation years later? Or do I just amputate outright with faster onset of the rehabilitation process? Medical professionals will gain a better perspective of the surgeon’s view and how our insights and knowledge can be shared.

This text can be read by, and be of benefit to, physicians, surgeons, physiatrists, physical and occupational therapists, rehabilitation nurses, consumers, counselors, prosthetists, and anyone else who interacts with the amputee population. All of the audiences will take away a better understanding of the care for amputees, especially when read in the context of all the collateral chapters reminding the reader of the interdependence of the rehabilitation team. These non-surgical chapters all highlight the importance of fluid lines of communication, cooperation, and old-fashioned teamwork. While some of the chapters will read with familiarity from the last edition, I found enough new insight and data to warrant re-reading a second and third time. Even seasoned practitioners will find new and credible information on many topics that they may not encounter on a daily basis. There are 30 chapters alone on major topics concerning management, pediatrics, and sports.

When considering whether to add this textbook to your own library, or another colleague's as a gift, one may ask if a book of this type is vital. With easy access to the Internet, is the "State of the Art" type of book even needed? Daily, we are probed and bombarded with data streaming through the Internet leaving us with the task of making useful information out of it. The Atlas has more than 75 contributors bringing 79 chapters of clearly written and concise information delineating "State of the Art" care of the amputee. When read in its entirety, the sum is greater than the parts. One of the contributors, Mr. Craig W. Heckathorne, MSc, opined optimistically, "The speed with which this chapter is transformed from a state-of-the-art review to a historical footnote will be a measure not only of the technologic advances in our culture but also of the vitality and earnestness of the community working to improve the capabilities of persons who use upper-limb components." I have this thought: to measure one's progress, one must know from where to start measuring.