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Reconstructive surgery in upper limbs in leprosy.

Collin Roy1, Nemai C Nath, Subodh Ranjan Saha

  • 1NRS Medical College and Hospital, Kolkata 700014.

Journal of the Indian Medical Association
|May 6, 2005
PubMed
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Leprosy deformities often affect limbs and face, frequently involving nerve damage. Surgical interventions, primarily tendon transfers, are crucial for restoring hand function in conditions like claw hand and wrist drop.

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).

Related Experiment Videos

  • 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.