02088nas a2200337   4500000000100000008004100001260001600042653001000058653000900068653001100077653001300088653001100101653000800112653001200120653002400132653002500156653002500181653000900206653001600215653002300231653002200254653002400276100001300300700001300313700001200326245007800338300001000416490000800426520130200434022001401736       1993                            d  c1993 Aug 2810aAdult10aAged10aFemale10aFibrosis10aHumans10aLeg10aleprosy10aLeprosy, Borderline10aLeprosy, lepromatous10aLeprosy, Tuberculoid10aMale10aMiddle Aged10aNerve Regeneration10aPeripheral nerves10aProspective Studies1 aMiko T L1 aMaitre C1 aKinfu Y00aDamage and regeneration of peripheral nerves in advanced treated leprosy.  a521-50 v3423 a<p>Despite the rapidly falling prevalence of leprosy, the disability and handicap resulting from loss of protective sensation, due to irreversible nerve damage, will remain a huge medical problem for many years. To elucidate the location and consequences of permanent nerve damage in treated leprosy, a prospective study involving nine patients who underwent leg amputation was conducted. Full-length nerves dissected from amputated legs were studied with histological and immunohistochemical methods. Our main findings were that: in both lepromatous and tuberculoid leprosy nerve damage increased distally, culminating in total destruction of dermal nerves and sensory nerve endings; after the therapy-related decrease of inflammation large-scale nerve regeneration took place; and that regenerating axons persisted for decades and in tuberculoid leprosy they might reach the subcutaneous fat of the plantar skin. We conclude that nerve regeneration was blocked by fibrous replacement of the distal-most nerves and nerve endings, and that the theoretical basis of nerve grafting in leprosy is in need of further clarification. In some patients, autologous transplantation of skin flaps, probably irrespective of the duration of loss of sensation, might help in regaining protective sensation.</p>  a0140-6736