Peroneal strength as an indicator in selecting route of tibialis posterior transfer for foot drop correction in leprosy.

OBJECTIVES: Tibialis posterior tendon transfer (TPT) technique, using either the Circum-tibial (CT) or Inter-osseus (IO) route is the standard surgical technique to correct foot drop. The selection of the route of transfer is usually dependent on the surgeon's preference. This study aims to identify criteria to help make that selection. SUBJECTS AND METHODS: A study was carried out on 381 feet during the period 1999 to 2010. All the patients operated during this period were included in the study. The CT route was used for those with peronei power 4 or 5, while the IO route was used when peronei power was 3 or less. RESULTS: In this case series the mean effective range of motion (above 90 degrees) was 11 and 12 degrees in CT and IO routes, respectively. The results were comparable in terms of rest position, active dorsiflexion and effective range of motion. All patients had a post-operative heel to toe gait, except for one of the 381 operated feet. Only three of the 381 feet had a reduction in navicular height of more than 2 cm, the medial arch being maintained in the others. CONCLUSIONS: TPT is a standard procedure to correct foot drop deformity in leprosy. Pre-selection for route of transfer, CT or IO, based on peronei strength avoids the complication of iatrogenic inversion. The technique of insertion and routine tendo-achilles lengthening provides a good range of movement. The deep tunnelling has not compromised the results, while giving excellent cosmetic appearance.

Efficacy of temporalis muscle transfer for correction of lagophthalmos in leprosy.

OBJECTIVES: Temporalis Muscle Transfer (TMT) is a surgical technique used to correct lagophthalmos in leprosy patients. We have evaluated the degree of success of TMT in achieving full lid closure, which is important in preventing damage to the cornea. SUBJECTS AND METHODS: A retrospective study was carried out on 69 patients who had TMT done, at one centre, on 101 eyes during the period of 1998-2009. Lid gaps on direct gaze and with both gentle and forced closure, as well as voluntary muscle testing of eye lid closure, were assessed using standard measuring techniques by a qualified physiotherapist. Associated problems due to lagophthalmos were recorded both pre- and post- operatively. Data were abstracted on to a special proforma and subjected to statistical analysis using SPSS. RESULTS: On completion of post-operative physiotherapy, 85% of the eyes could achieve full lid closure with no measurable gap. The mean (SD) lid gap on forced closure was 48 (2.8) mm pre-operatively and 0.2 (0.5) mm at the end of the in-patient stay. The mean (SD) lid gap on gentle closure was 7.9 (2.6) mm preoperatively and 2.4 (1.8) mm post-operatively. The mean (SD) vertical inter-palpebral distance, during straight gaze, was reduced from 12.6 (1.6) pre-operatively to 9.8 (1.2) postoperatively. Exposure keratitis cleared in 16 of 27 eyes (60%) and Epiphora cleared or improved in 31 eyes. CONCLUSIONS: It is concluded that the TMT is a successful option (cosmetically and functionally) for correction of lagophthalmos.