Silicone implants for muscular wasting of first web and the hypothenar muscles.

Medial nerve and Ulnar nerve palsy are still very common in spite of MDT. While most surgeons are concerned with the function of the hand, few have paid attention to the aesthetics of it. However 'white-collar' patients are concerned about the appearance of their hands -besides the function, therefore they would like us to do something for the muscular wasting which is so common. We propose here a new technique, used for the last 10 years, and demonstrate its results.

Claw-toes correction: personal technique.

Claw-toes deformity is quite common in leprosy because the Posterior Tibial nerve, the nerve supplying the intrinsics of the toes, is often affected. The authors present the details of technique standardized by them for correction of claw-toes of grade 1 and 2. This technique has been successfully used in 485 toes (144 patients).

Salvage surgery for severely deformed hands in leprosy.

Results of surgery of nine cases of severely deformed hands (considered "useless/hopeless") and the techniques used in each of them to achieve a 'functional hand' are described. The techniques used were: Pollicization of Prof G Brunelli, Cocked-hat technique of Gillies, JESS distractor of BB Joshi. All patients had good results after surgery. However, two patients developed some deformity because of insensitive hands'; This type of surgery is not done routinely but authors would like to encourage other surgeons to try these techniques as hands of a number of patients can be made 'functional' by any of these procedures.

Joshi External Stabilising System (JESS) in proximal interphalangeal joint (PIP) contractures in leprosy.

The authors present their experience in the use of the JESS (Joshi External Stabilising System) for correction of proximal interphalangeal joint (PIP joint) contracture deformity in 68 fingers. The use of the JESS has made this surgery easier, faster in releasing contractures and it has given better correction than the methods so far used by the same authors, like capsulotomy, local flaps and free skin grafting. The procedure is simple and has no serious side effects; it can be repeated if need be. The JESS is easy to apply, economical, reliable, reusable, well accepted by the patient. Compared to the other distractors made in USA and Europe, the JESS has an added advantage in that it costs so very much less (US $5-10), that our leprosy hospitals can afford it. In our patients, we have achieved full extension in 75% and good extension in 10.3% of the cases. These figures are much better than what was possible, in the past, with local flaps and free skin grafting. With those procedures we had excellent results in only 53% of the cases and poor result in 28%.