Results of thumb correction in leprosy using different techniques

Area of Science:

• Hand surgery
• Reconstructive surgery
• Leprosy treatment

Background:

• Leprosy frequently causes intrinsic hand muscle paralysis, leading to functional deficits.
• Opponensplasty and lumbrical replacement are crucial for restoring hand function.

Purpose of the Study:

• To evaluate the effectiveness of different surgical techniques for correcting thumb paralysis in leprosy patients.
• To compare outcomes of opponensplasty using flexor digitorum superficialis (FDS) and extensor indicis proprius (EIP) tendons.
• To assess the correction of low ulnar paralysis with Froment's sign.

Main Methods:

• Surgical correction of intrinsic hand muscle paralysis in 44 hands of 42 leprosy patients.
• Techniques included opponensplasty (FDS4 or EIP), lumbrical replacement (direct lasso), and FPL to EPL tendon transfer for ulnar paralysis.
• Results were analyzed in 37 hands of 35 patients with a mean follow-up of 19 months.

Main Results:

• Transfer of the radial half of the flexor pollicis longus (FPL) to the extensor pollicis longus (EPL) provided the best thumb correction outcomes.
• Flexor digitorum superficialis (FDS) transfer yielded good results in 12 out of 16 manual workers.
• Extensor indicis proprius (EIP) transfer was effective but resulted in less thumb power and patient satisfaction.

Conclusions:

• Tendon transfer of the radial half of FPL to EPL is the most effective method for correcting thumb paralysis in leprosy.
• FDS and EIP transfers are viable alternatives, with FDS showing promise for manual laborers.
• Surgical reconstruction significantly improves hand function in leprosy patients with intrinsic muscle paralysis.