Leprosy Reconstruction Surgery

Restoring Function and Form: Leprosy Reconstruction Surgery

Leprosy, a chronic infectious disease primarily affecting the skin, nerves, upper respiratory tract, eyes, and testes, can lead to significant physical deformities if left untreated or if treatment is delayed. While modern multi-drug therapy (MDT) effectively cures the disease, the nerve damage caused by Mycobacterium leprae can result in permanent disabilities. Thankfully, reconstructive surgery plays a vital role in restoring function, improving appearance, and enhancing the quality of life for individuals affected by these sequelae. This specialized field of surgery addresses common deformities such as claw hand, foot drop, and lagophthalmos, allowing individuals to regain independence and reintegrate into society.

Claw Hand in Leprosy

One of the most debilitating deformities caused by leprosy is the “claw hand”, a consequence of ulnar and median nerve damage. This nerve damage leads to paralysis of the intrinsic muscles of the hand, causing the fingers to hyperextend at the MCP joints and flex at the IP joints, resembling a claw.

This significantly impairs the ability to grasp, pinch, and perform fine motor tasks, severely impacting daily activities and vocational prospects.

Claw Hand Correction

Claw hand correction primarily involves tendon transfer surgeries. The goal is to re-route healthy, working tendons from unparalyzed muscles (often from the wrist or forearm) to replace the function of the paralyzed intrinsic muscles.

Common procedures include the Brand’s procedure or modified Brand’s procedure, which aim to restore extension at the MCP joints and improve finger flexion.

These intricate surgeries, when successful, can dramatically improve hand function, enabling patients to hold objects, write, and engage in meaningful work — thereby restoring a sense of normalcy and dignity.

Foot Drop Deformity

Foot drop is another common and disabling consequence of leprosy-related nerve damage, specifically affecting the common peroneal nerve. This damage leads to paralysis of the muscles responsible for dorsiflexion of the foot (lifting the front part of the foot). As a result, the foot drags during walking, leading to a characteristic “steppage gait” where the leg is lifted high to avoid tripping. This not only increases the risk of falls but also causes significant functional limitations and social embarrassment. Surgical correction for foot drop often involves tendon transfers, similar to claw hand correction. Tendons from active muscles, such as the tibialis posterior (which normally inverts and plantarflexes the foot), can be transferred to the front of the ankle to act as dorsiflexors. In some cases, fusion of the ankle joint (arthrodesis) may be considered for severe and longstanding deformities to provide stability. Successful foot drop correction significantly improves gait, reduces the risk of falls, and allows individuals to walk with greater ease and confidence, facilitating participation in social and economic activities.

Lagophthalmos Correction

Lagophthalmos refers to the inability to completely close the eyelids, a severe complication resulting from facial nerve damage in leprosy. This condition leaves the cornea exposed to the environment, leading to chronic dryness, irritation, and a high risk of corneal ulcers, infections, and ultimately, blindness. Prompt and effective correction is crucial to preserve vision. Surgical management of lagophthalmos aims to achieve complete eyelid closure and protect the eye. One of the most common and effective procedures is the insertion of a gold weight into the upper eyelid. The weight of the gold helps to passively pull the upper eyelid down, facilitating closure when the person blinks or sleeps. In other cases, muscle transfers from the temporalis muscle (temporalis muscle transfer) or the use of springs may be employed to provide dynamic eyelid closure. These interventions are vital in preventing irreversible eye damage, preserving precious eyesight, and significantly improving the patient’s quality of life. In conclusion, leprosy reconstruction surgery is a beacon of hope for individuals living with the long-term consequences of the disease. By addressing deformities like claw hand, foot drop, and lagophthalmos, these specialized procedures not only restore physical function and improve appearance but also empower individuals to regain their independence, dignity, and a fulfilling life. Continued advancements in surgical techniques and increased access to these vital services are crucial in our ongoing efforts to support those affected by leprosy.