Reconstructive Surgery in Leprosy

Dr. MD AKBAR KHANMS (ORTHO)

ASSISTANT PROFESSOR

A C S R Government medical college, nellore

Reconstructive Hand & Foot SurgeonDamien Foundation india trust

Nellore

Introduction

Two important organs are damaged in leprosy The Skin The Nerves

Pathogenesis

Mycobacterium leprae Infiltrates peripheral nerves

Destruction of Schwann cells and axons

CD4 + T-cell-mediated granulomatous process

Impairments of nerve function

Deformities in leprosy

Cascade of destructive events with intense intraneural oedema

Affection of Nerves in Leprosy

Sensory loss in peripheral nerves

Lateral popliteal(common peroneal)

Facial

Radial

Posterior tibial

Ulnar

Median

Clawing of the toes & collapse of foot arches

Lagophthalmos

Wrist-drop

Clawing of Ring & little fingers Z thumb

Clawing of index & middle fingers Ape thumb

Foot-dropIntrinsic muscles of the foot

Intrinsic muscles of Hand

Paralysis of orbicularis oculi

Paralysis of thumb, fingersand wrist extensors

Paralysis of peroneal muscles & dorsiflexors of foot

Paralysis of thenar muscles

Grip in claw hand

Normal grip Roll up Maneuver

Loss of Grasp

Grip & Grasp in Claw Hand

Aim of Reconstructive Surgery

Augment its capabilities for the activities of daily living (ADL)

Restore form and structure adequately to accelerate the patient’s integration into society

Selection of Patient

All deformities should be completely mobile

Patients should be motivated for surgery

Surgery according to priority: Young patients Patients with mobile claw hand Deformity - preferably one year or more. Patients with a job who are unable to

perform their jobs due to their disability or the ones who will lose their job due to the disability

Case –1 (Ulnar Claw Hand)

Main en griffe

Claw Hand – FDS Middle Finger

Post op – Claw Hand

1st Week: Repeat the exercises before surgery

2nd Week: Co-ordination exercises of 2-5 fingers（ Keep lumbrical position)

3rd – 4th Week: Function exercises（ grasping, holding, making fist, etc.)

Post op

Case –2 (Ape ThumbDeformity)

Opponensplasty – FDS Ring Finger

Post –Op Rehabilitation

1st Week: Repeat the exercises before surgery

2nd Week: Touch the pulp of ring finger with thumb

3rd – 4th Week: Function exercises（ pinching, grasping, holding, making fist, etc.)

Case- 3 ( Foot Drop Left)

Foot Drop – TPT Transfer

Post –op - Foot drop

1st week： Isolate

exercise repeat the

pre-operative exercises

2nd Week: Co-ordination

exercises

3rd Week: stand up, adjust weight

4th Week: Gait exercise（ face the mirror）

After Surgery & Physiotherapy

Case 4- Lagophthalmos

Lagophthalmos - Temporalis

After surgery & physiotherapy

Case 5 :Nerve Abscess

Neurolysis -Ulnar Nerve Abscess

Longitudinal epineurotomy

Case 6 Gangrene Great Toe

Supervised post-operative therapy

This is essential after all reconstructive operations

After removal of the cast suitable protective/static splinting is provided.

Post-operative re-education is provided in a staged manner, being easier for single tendon transfers.

POP - Dynamic splints night,

Reconstructive Surgery

GOI, GOAP & Damien Foundation India Trust

Reconstructive Surgery in Leprosy Pre-op Physio – 1 week Surgery - 1 week Splinting for - 2-3 weeks Post op physio – 1 month

Cleyson Mupfiga HUB117 2011 31

Cleyson Mupfiga HUB117 2011 32

Questions ????

THANK YOU