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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