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.

Hand atrophy in a leprosy patient--treatment with polymethylmethacrylate.

Leprosy, an infectious disease caused by Mycobacterium leprae, affects mostly the skin and peripheral nerves. The polymethylmethacrylate has been used as bone cement, knee and intraocular implants as a bioexpansor, filling the area where it is applied. We describe the case of a Brazilian male with tuberculoid leprosy who developed muscular wasting between the metacarpals of both hands. Ten years after leprosy treatment, he was submitted to five applications of 10% polymethylmethacrylate. The treatment was successful, improving the appearance of his hands leading to a positive impact on the patient's life.

Temporoparietal fascial free flap for correction of first web space atrophy.

Fourteen temporoparietal fascial free flaps were used for correction of first web space atrophy from ulnar nerve palsy in 13 patients. Ten sustained ulnar nerve injuries and three suffered from leprosy. The procedures were performed under general anesthesia except one leprosy patient with bilateral ulnar nerve palsy in which local anesthesia and brachial block were employed to harvest bilateral free flaps and recipient site preparations, respectively. The follow-up time varied from 4 to 64 months. The postoperative results were satisfactory and there was no resorption of the free flaps. The consistency of the augmented first web space was soft and compressible like natural feel. The size of the flap was more than enough for augmentation of first web space and donor site morbidity was minimal and accepted by all patients. We conclude that temporoparietal fascial free flap is an ideal autogenous tissue for correction of first web space atrophy.

Carvable silicone rubber prosthetic implant for atrophy of the first web in the hand.

Muscular atrophy of the first web space in the hand is a common finding following ulnar nerve palsy and this deformity is very stigmatizing among leprosy patients in some countries and cultures. We present our experience with the carvable soft-silicone rubber block implant to correct this deformity. We discuss the procedure, results and advantages over other techniques. Fifteen operations were performed at the 'Lauro de Souza Lima' Research Institute, Bauru, Brazil during a period of six years. One complication was encountered due to an implant that was too large. The results were considered good in twelve instances and fair in three.

[Clinical manifestations of leprous multineuritis in the West African. 90 cases (author's transl)]. / Manifestations cliniques de la multinévrite lépreuse chez l'africain de l'ouest. A propos de 90 observations

The neurologic examination of 90 leprosy subjects shows the importance of nerve enlargement and associated sensorimotor deficiencies. The association of various clinical signs, the ones in contrast to the others and the influence of the history of the illness are taken in consideration. Finally these results are compared with some previous works.