Reconstructive surgery in upper limbs in leprosy.

Area of Science:

• Orthopedics
• Neurosurgery
• Plastic Surgery

Background:

• Leprosy commonly causes deformities, with 80% requiring minor surgery and the remainder major surgery.
• Upper and lower limbs, along with the face, are the primary sites affected by leprosy-related deformities.
• Nerve involvement, typically median or ulnar nerves, and occasionally the radial nerve, is a key factor in these deformities.

Purpose of the Study:

• To outline surgical strategies for correcting deformities caused by leprosy.
• To detail reconstructive methods for nerve palsies affecting the hand and wrist.

Main Methods:

• Tendon transfer is highlighted as the primary surgical option for deformities such as simian hand, ulnar claw hand, and wrist drop.
• Specific reconstructive techniques are mentioned for median nerve palsy (opponensplasty) and radial nerve palsy (FCU, FDS, FCR transfers).
• For ulnar nerve palsy, restoration of intrinsic hand function involves utilizing available motors and fascia lata grafts; static methods are employed for extensive paralysis.

Main Results:

• Tendon transfer is identified as the sole effective method for specific deformities like simian hand and wrist drop.
• Opponensplasty is the established procedure for median nerve palsy.
• Various tendon transfers and grafts are detailed for restoring function in radial and ulnar nerve palsies, including static corrections for severe cases.

Conclusions:

• Surgical reconstruction, particularly tendon transfers, plays a vital role in managing leprosy-induced deformities and nerve palsies.
• A range of surgical techniques exist to restore function to affected limbs, tailored to the specific nerve involvement and deformity.
• Addressing nerve involvement through reconstructive surgery is essential for improving quality of life in leprosy patients.