ABSTRACT
Neurophatic foot ulceration (NFU) is a common problem in leprosy patients. Three cases of NFU, who did not respond to conservative measures, were treated with orthopaedic surgery. The purpose of the treatment was, by using different approaches, the reduction of bone hyper pressure areas, allowing the ulcer to heal.
Subject(s)
Foot Ulcer/surgery , Leprosy/complications , Aged , Female , Foot Deformities, Acquired/diagnostic imaging , Foot Deformities, Acquired/etiology , Foot Deformities, Acquired/pathology , Foot Deformities, Acquired/surgery , Foot Ulcer/diagnostic imaging , Foot Ulcer/etiology , Foot Ulcer/pathology , Humans , Middle Aged , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
A majority of heel ulcers, at least to begin with, extend to dermis or to the fat pad in its superficial part and an appropriate skin closure can heal these ulcers as most of the padding is in tact. Since the skin is adherent to the deeper structures with fibrous bands it has to be stretched or undermined (by cutting the fibrous bands) to close the wound without tension. 17 feet in 11 patients (10 males; one female) in the 12-54 year age-group were operated upon and followed up. Because skin is adherent to deeper tissues by fibrous septae, stretching of skin was planned to mobilize it for a tension-free closure. Of the 17 feet, 13 could be re-examined after 30 months or more. Most of the minor recurrences were seen in the first 6 months after surgery. Major recurrences were seen in 2 feet (one case). The suture line did not show hyperkeratosis and the scar merged well into the surrounding skin after one year. Available data suggest that simple heel ulcers can be made to heal with a good scar by skin-stretching and suture, and, by radiography of the foot, it is worth separating those cases in which ulcer is not extending deep involving calcaneum. The size of the ulcer in heel is important for the success of the operation. The procedure is not intended for big wounds (>15 mm in width).
Subject(s)
Foot Ulcer/surgery , Heel , Leprosy/complications , Tissue Expansion , Adolescent , Adult , Child , Female , Foot Ulcer/diagnostic imaging , Foot Ulcer/pathology , Heel/diagnostic imaging , Humans , Leprosy/surgery , Male , Middle Aged , Radiography , Suture TechniquesABSTRACT
Practically leprous plantar ulcers (PU) are difficult to treat and heal under field condition. Considering the important number of patients showing a PU, the directors of national leprosy control programmes are determined, within the programmes on prevention of disabilities (POD), to treat the PU in the field. Therefore it appears to be essential to codify and simplify their treatment thus enabling it to be effective. The healing of PU being the only criteria of effectiveness of the technique. Four clinical stages were defined, each corresponding to a precise way of treatment using only essential and basic products at low cost. During the trainings about the treatment techniques and attitudes much emphasize is given on the discharge of the PU, on the trimming of the wound and on the products to use according to PU's evolutionary stage.