ABSTRACT
The commonest paralytic deformity in leprosy is the claw deformity of the fingers. Many surgical procedures have been described and are practiced to correct this deformity, but none is free from complications. A modification of the Zancolli lasso operation in which only half of the flexor digitorum superficialis tendon of the middle finger was used as the motor is described and a comparative study of this and the conventional procedure was carried out in 70 hands in 70 patients. The results suggest that the modification is technically simpler, with comparable results to those of the conventional procedure and fewer complications.
Subject(s)
Finger Joint/surgery , Hand Deformities, Acquired/microbiology , Hand Deformities, Acquired/surgery , Leprosy/complications , Tendon Transfer/methods , Adolescent , Adult , Cohort Studies , Female , Finger Joint/pathology , Finger Joint/physiopathology , Hand Deformities, Acquired/physiopathology , Humans , Leprosy/pathology , Leprosy/surgery , Male , Metacarpophalangeal Joint/physiopathology , Metacarpophalangeal Joint/surgery , Middle Aged , Range of Motion, Articular , Recovery of Function , Retrospective Studies , Treatment OutcomeABSTRACT
A total of 38 patients with leprosy and localised nerve damage (11 median at the wrist and 37 posterior tibial at the ankle) were treated by 48 freeze-thawed skeletal muscle autografts ranging between 2.5 cm and 14 cm in length. Sensory recovery was noted in 34 patients (89%) and was maintained during a mean period of follow-up of 12.6 years (4 to 14). After grafting the median nerve all patients remained free of ulcers and blisters, ten demonstrated perception of texture and eight recognised weighted pins. In the posterior tibial nerve group, 24 of 30 repairs (80%) resulted in improved healing of the ulcers and 26 (87%) demonstrated discrimination of texture. Quality of life and hand and foot questionnaires showed improvement; the activities of daily living scores improved in six of seven after operations on the hand, and in 14 of 22 after procedures on the foot. Another benefit was subjective improvement in the opposite limb, probably because of the protective effect of better function in the operated side. This study demonstrates that nerve/muscle interposition grafting in leprosy results in consistent sensory recovery and high levels of patient satisfaction. Ten of 11 patients with hand operations and 22 of 25 with procedures to the foot showed sensory recovery in at least one modality.
Subject(s)
Ankle/surgery , Leprosy/surgery , Muscle, Skeletal/transplantation , Nerve Regeneration/physiology , Transplantation, Autologous/methods , Wrist/surgery , Activities of Daily Living/psychology , Adolescent , Adult , Female , Humans , Leprosy/pathology , Male , Quality of Life/psychology , Treatment Outcome , Ulcer/pathologySubject(s)
Leprosy/surgery , Muscles/transplantation , Peripheral Nerves/surgery , Adolescent , Adult , Female , Foot/innervation , Foot/surgery , Hand/innervation , Hand/surgery , Humans , Leprosy/physiopathology , Male , Median Nerve/surgery , Middle Aged , Peripheral Nerves/physiopathology , Sensation , Tibial Nerve/surgery , Transplantation, AutologousABSTRACT
A new method for testing sensibility in the sole of the foot is described. In this method the ability to distinguish different surfaces while walking is assessed. This dynamic, functional and more objective test is recommended as an additional tool to evaluate sensibility in the sole of the foot.
Subject(s)
Foot/innervation , Neurologic Examination , Peripheral Nervous System Diseases/diagnosis , Humans , Leprosy/complications , Neurologic Examination/instrumentation , Neurologic Examination/methods , Peripheral Nervous System Diseases/etiology , Tibial Nerve/physiopathologySubject(s)
Leprosy/complications , Peripheral Nervous System Diseases/etiology , Humans , Leprosy/drug therapy , Leprosy/physiopathology , Nerve Degeneration , Nerve Regeneration , Peripheral Nervous System Diseases/physiopathology , Peripheral Nervous System Diseases/prevention & control , Peripheral Nervous System Diseases/therapy , Sensation Disorders/etiology , Sensation Disorders/physiopathology , Sensation Disorders/prevention & control , Sensation Disorders/therapySubject(s)
Humans , Nervous System Diseases , Peripheral Nervous System Diseases/etiology , Peripheral Nervous System Diseases/physiopathology , Peripheral Nervous System Diseases/prevention & control , Peripheral Nervous System Diseases/therapy , Leprosy/complications , Leprosy/physiopathology , Leprosy/drug therapyABSTRACT
Autologous muscle grafts were used to repair 12 mixed peripheral nerves (9 posterior tibial, 3 median) in 10 patients with leprosy who had total anaesthesia and analgesia of the area supplied by the nerve. Postoperatively, 7 patients reported improved sensation in the foot or hand, with a return of vibration sense and joint position sense in 11 and of perception of a 10 g pin in 5; the ability to sweat in the affected area was also restored in 7.
