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Nerve repair by denatured muscle autografts promotes sustained sensory recovery in leprosy.

Abstract

A total of 38 patients with leprosy and localised nerve damage (11 median at the wrist and 37 posterior tibial at the ankle) were treated by 48 freeze-thawed skeletal muscle autografts ranging between 2.5 cm and 14 cm in length. Sensory recovery was noted in 34 patients (89%) and was maintained during a mean period of follow-up of 12.6 years (4 to 14). After grafting the median nerve all patients remained free of ulcers and blisters, ten demonstrated perception of texture and eight recognised weighted pins. In the posterior tibial nerve group, 24 of 30 repairs (80%) resulted in improved healing of the ulcers and 26 (87%) demonstrated discrimination of texture. Quality of life and hand and foot questionnaires showed improvement; the activities of daily living scores improved in six of seven after operations on the hand, and in 14 of 22 after procedures on the foot. Another benefit was subjective improvement in the opposite limb, probably because of the protective effect of better function in the operated side. This study demonstrates that nerve/muscle interposition grafting in leprosy results in consistent sensory recovery and high levels of patient satisfaction. Ten of 11 patients with hand operations and 22 of 25 with procedures to the foot showed sensory recovery in at least one modality.

More information

Type
Journal Article
Author
Pereira J H
Palande D D
Narayanakumar T S
Subramanian A S
Gschmeissner S
Wilkinson M
Year of Publication
2008
Journal
The Journal of bone and joint surgery. British volume
Volume
90
Issue
2
Number of Pages
220-4
Date Published
2008 Feb
Language
eng
ISSN Number
2044-5377
DOI
10.1302/0301-620X.90B2.19586
Alternate Journal
J Bone Joint Surg Br
Publication Language
eng