SURGERY IN LEPROSY

SURGERY IN LEPROSY.

DEFINITION

 

 Leprosy is a Chronic granulomatus  inflammatory disease caused due to infection by mycobacterium leprae .

 

– There are 3 types

 

√ Tuberculoid

√ Borderlined

√ Lepromatous

 

• Deformities in Leprosy

 

1) Primary :

* Hand :

✓ Total claw hand

✓ Banana fingers ( swelling on back of hand and finger )

✓ Ulnar claw hand

✓ Ape thumb deformity.

 

* Foot

✓ Foot drop plantar ulcers

 

* Face

✓ Collapse of bridge of nose

✓ Madarosis ( Loss of lateral portion of eyebrows )

✓ Fascial palsy

✓ Leonine face ( multiple nodules )

✓ corneal ulcer.

 

2) Secondary

 

– Due to paralysis of muscles and anesthesia

– Trophic ulcers

 

• Defomity

 

– Deform means out of shape

– Deformation or deviation of body parts or segments from normal anatomical alignment is deformity.

 

* Type of deformity

 

– Congenital : CTEV

– Acquired : Degenerative conditions, trauma / injury , muscular imbalances.

 

* Grading of deformity

 

– There are three grades

Grade 1 : tightness

Grade 2 : varying from tightness to contracture.

Grade 3 : Bony deformity with contracture.

 

(1) Foot drop

 

– Foot drop is a deformity seen in leprosy results in paralysis of muscles supplied by common peroneal nerve ( superficial and deep )

– Muscles supplied by these nerves are peroneus longus and brevis ( superficial ) and tibialis anterior ( deep branch or anterior tibial nerve )

* Clinical features

 

– Loss of Dorsiflexion of foot

– Diminision in sensation

– Gait : high stepping gait

– plantar ulcers

 

* Tendon transfer in foot drop

 

– Tibialis posterior muscle is transferred to dorsum of foot either by subcutaneous tissue or interossei membrane.

– And is inserted at base of 2 nd or 3 rd metatarsals.

 

* Splinting

 

– dynamic foot drop splint

– Static foot drop splint

(2) Ulnar claw hand ( C8 – T1 )

 

* Muscles paralyzed ;

 

√ Palmaris brevis

√ 2 lumbricals from medial side

√ Hypothenar muscles : flexor digiti minimi , abductor digiti minimi , opponence digiti minimi , palmar and dorsal interossei , adductor pollicis, flexor carli ulnaris.

 

* Clinical features

 

– Sensory loss ( medial 1/2 fingers)

– Hyperextension of MCP , Flexion of DIP , PIP of 4 th and 5 th finger

– Paralysis of lumbricals

– wasting of hypothenar and interossei muscles

 

* Clinical tests

 

– Forments test

– Card test

– Egawas test

 

* Tendon transfer (Bunnell’s operation)

 

– Flexor digitorum sublimis is detached and split into 2 slips and is inserted to extensor aspect of little and ring finger

 

(3) Total claw hand ( True claw hand )

 

– Both ulnar and median nerve are injured .

* Muscles supplied by median nerve ( C6, C7, C8, T1 )

– Thenar muscles

– abductor pollicis brevis

– flexor pollicis brevis

– opponence pollicis

– 2 Lumbricals ( from lateral side )

– Palmaris longus

– flexor digitorum profundus and superficialis

– flexor pollicis longus

– pronator teres

– flexor carpi radialis

 

* Clinical features

 

– sensory loss in medial 1 – 1/2 fingers due to ulnar nerve and lateral 3-1/2 fingers due to median nerve

– Hyperextension of metacarpophalangeal joints of all 4 fingers

– labourer’s nerve

– ape thumb deformity

 

* Clinical tests

 

– pen test

– pointing index or oschner’s clasp test

– benediction test

– test for ulnar nerve injury

 

* Tendon transfer

 

1) brands many tailed tendon transfer

– Extensor carpi radialis longus tendon is detached and lengthened

– Palmaris longus tendon is split longitudinally into 4 slips and is then attaches to extensor expansion of fingers

 

2) Bunnell’s opponence palsy

– For restoration of thumb opposition and abduction

– Transfer of flexor digitorum sublimis of little finger to the base of thumb

 

* Splinting

 

– Knuckle bender splint

– Median nerve splint

– Static 2 dynamic splinting.

 

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