ABSTRACT
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/pathologyABSTRACT
There is now a better understanding of the scope and process of rehabilitation. The approach recognizes the impact of leprosy on the individual, aims to understand the needs and concerns of those affected, their families and community in the rehabilitation process, and that aims to restore the person to normal social life. LEPRA India has undertaken socio-economic rehabilitation (SER) activities in its projects in Andrah Pradesh and Orissa States in India with a holistic approach that has been evolutionary, developmental and participatory. A SER Officer (SERO) was posted to each project. A plan was formulated by the SERO with participation of all project staff. The main emphasis of the programme was on active participation of the affected person in the rehabilitation process. A needs-assessment study was conducted in the target population using a semi-structured questionnaire. Information was elicited about social and economic status, before and after the disease, and the current rehabilitation needs of the persons affected. The next step was meeting the needs through interventions by the SER staff. The impact of the programme on restoration of social and economic status of the affected persons was analysed. The paper stresses the importance of assessing the needs of persons affected by leprosy, structuring a rehabilitation programme with the active participation of the affected person and evaluating the impact of the interventions in restoring normal social and economic life.
Subject(s)
Guidelines as Topic , Health Services Needs and Demand , Leprosy/rehabilitation , National Health Programs/organization & administration , Adult , Aged , Female , Humans , India , Male , Middle Aged , Program Development , Program Evaluation , Severity of Illness Index , Social Class , Socioeconomic FactorsSubject(s)
Leprosy , Surgical Procedures, Operative , Congenital Abnormalities , Hospitals, DistrictSubject(s)
Foot Deformities, Acquired/therapy , Hand Deformities, Acquired/therapy , Leprosy/complications , Peripheral Nervous System Diseases/prevention & control , Foot Deformities, Acquired/etiology , Hand Deformities, Acquired/etiology , Humans , Peripheral Nervous System Diseases/etiology , Peripheral Nervous System Diseases/therapyABSTRACT
Methods of examining and diagnosing damage to nerves commonly involved in leprosy are described. The equipment used is inexpensive, gives reliable and repeatable results and is useful in making objective assessments in terms of function in everyday living.
Subject(s)
Leprosy/diagnosis , Neurologic Examination/methods , Humans , Neurologic Examination/instrumentation , Peripheral Nervous System Diseases/diagnosisABSTRACT
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.
Subject(s)
Leprosy/surgery , Muscles/transplantation , Adolescent , Adult , Female , Humans , Male , Nerve Regeneration , Nervous System Diseases/surgery , Peripheral Nerves/surgery , Pilot Projects , Sensation/physiology , Sweating/physiologyABSTRACT
Mycobacteria were present in 4 out of 8 mixed peripheral nerve trunks from patients (3 BT and 1 BL) treated with DDS and/or MDT for periods ranging from 21 months to 8 years. Most of the bacilli appeared to be 'whole'. Nerve destruction with areas of granulomatous infiltration appeared more active than expected. Possible reasons for a continued presence of bacilli in treated nerves and its implications in 'relapse' are discussed.
