[Effect of different surgical methods on leprosy plantar ulcers].

OBJECTIVE: To explore the effects of different surgical methods on plantar ulcers in leprosy.

METHODS: The clinical data of 71 patients with leprosy plantar ulcers and treated with different surgical methods between October 1950 and October 2006 were analyzed retrospectively. In group A, 34 cases underwent debridement, including 26 males and 8 females aged 53-88 years old (average 72.4 years old); the course of ulcer averaged 29.0 years; the size of ulcer ranged from 5 cm x 3 cm x 2 cm to 11 cm x 7 cm x 3 cm; the disability degrees of the affected foot was mild in 25 cases and severe in 9 cases according to the self-designed evaluation system. In group B, 22 cases received foot pressure rebuilding surgery, including 19 males and 3 females aged 48-83 years old (average 69.8 years old); the course of ulcer averaged 33.5 years; the size of ulcer ranged from 5 cm x 3 cm x 2 cm to 12 cm x 7 cm x 3 cm; the disability degrees of the affected foot was mild in 12 cases and severe in 10 cases. In group C, 15 cases were repaired with the transposition of toe flap, foot arch flap, acrotarsium flap, or medial tibia flap, including 11 males and 4 females aged 43-73 years old (average 64.6 years old); the course of ulcer averaged 29.3 years; the size of ulcer ranged from 6 cm x 3 cm x 2 cm to 11 cm x 5 cm x 3 cm; the disability degrees of the affected foot was mild in 9 cases and severe in 6 cases. No significant differences were evident among three groups in terms of the general information (P > 0.05), except for the difference between group A and group C on age (P < 0.05).

RESULTS: Group A: 19 out of 34 cases healed and the average healing time was 46.8 days; all patients were followed up for 2-45 years (average 17.2 years); the rate of ulcer healing 1 year after operation was 55.9% (19/34); 12 healed ulcer patients relapsed at average 1.5 years after operation; the rate of ulcer healing at last follow-up was 20.6% (7/34). Group B: 18 out of 22 cases healed and the average healing time was 29.2 days; all patients were followed up for 2-50 years (average 13.3 years); the rate of ulcer healing 1 year after operation was 81.8% (18/22); 7 healed ulcer patients relapsed at average 3.3 years after operation; the rate of ulcer healing at last follow-up was 50.0% (11/22). Group C: 14 out of 15 cases healed and the average healing time was 27.1 days; all patients were followed up for 3-12 years (average 8.8 years). The rate of ulcer healing 1 year after operation was 93.3% (14/15); 7 healed ulcer patients relapsed at average 4 years after operation; the rate of ulcer healing at final follow-up was 46.7% (7/15). For the rate of ulcer healing 1 year after operation, there was a significant difference between group A and group B, and between group A and group C (P < 0.05), but no significant difference was evident between group B and group C (P > 0.05). For the rate of ulcer healing at the final follow-up visit, there was a significant difference between group A and group B (P < 0.05), but no significant difference was evident between group A and group C, and between group B and group C (P > 0.05).

CONCLUSION: The surgical treatment of plantar ulcers in leprosy should include the alleviation of the plantar high-pressure zone and the transposition of the flaps, providing good short-term and long-term therapeutic effect.