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.

A method used to access the functional outcome of tibial posterior tendon transfer for foot drop in leprosy.

OBJECTIVES: The aim of this study was to access the postoperative functional results of posterior tibial tendon transfer for foot drop as a consequence of nerve palsy in leprosy. MATERIAL AND METHODS: Thirteen patients (9 males and 4 females) with ages ranging from 9 to 69 years were submitted to posterior tibial tendon transfer by the circumtibial route to correct foot drop in leprosy. The length of postoperative follow-up ranged from 1 to 5 years. The Stanmore system was used as a method for evaluating the functional results of postoperative posterior tibial tendon transfer. This system is made up of 7 different categories and the total score is 100. RESULTS: According to the Stanmore system, the results were poor in 1 patient (7.6%), moderate in 2 feet (15.3%), good in 5 feet (38.4%), and excellent in 5 feet (38.4%). All the patients were satisfied with the final outcome. CONCLUSION: The posterior tibial tendon transfer for foot drop in leprosy was efficient in restoring normal function of the foot and gait without changing foot posture. In the absence of a standardized method for assessing the results of posterior tibial tendon transfer, the Stanmore system seems to be a good tool for an objective evaluation.

Abductor pollicis longus deviation graft operation: modified for stabilizing CMC and MCP joints of 'intrinsic minus' thumb.

The original procedure abductor pollicis longus deviation graft operation by Beine (1996) was introduced to correct retroposition of the thumb and to balance the instability at the carpometacarpal (CMC) joint in cases of ulnar-cum-low median palsy in leprosy, so that bone-using procedures can be avoided to some extent. It provides an antagonistic force to the action of the abductor pollicis longus (abd. pol. long.) by giving this muscle a second insertion, with the result that the action of the abd. pol. long. now stabilises to a considerable extent the CMC joint in its mid-rotational position by a partial replacement of the action of the opponens pollicis (opp. pol.) and abductor pollicis brevis (abd. pol. brev.). Experience over five years with the original procedure showed us that it can make an ulnar deviation more visible at the MCP joint of the thumb. The modification of the procedure corrects this as well, as the results in 12 hands of 11 patients have shown. Interestingly, of the 11 patients who underwent operation, one was not a leprosy patient, but referred to us for partial triple palsy of the left hand and arm without sensory loss. It is shown that the indication of this procedure is wider than mentioned earlier.

Comparative evaluation of effectiveness of different motor muscles in modified lasso procedure for correction of finger clawing.

A retrospective study was carried out to compare the effectiveness of different muscles as motors in modified lasso procedures for correction of finger clawing in leprosy. It was observed that palmaris longus and extensor carpi radialis longus were more suitable than the flexor digitorum superficialis. In some patients, removal of superficialis is associated with complications which could not be predicted before surgery. Extensor carpi radialis longus has advantages over palmaris longus in selected cases.

Palmaris longus--a muscle with multiple uses in leprosy-affected hands.

The present paper reviews the anatomy of palmaris longus muscle and also the situations where palmaris longus muscle has been used as an independent motor or as a donor of tendon graft material. Its relevance in leprosy-affected hands is also discussed because the muscle is usually spared in hand palsies consequent to leprotic neural damage. The advantages and disadvantages of its use in different operative procedures have been analyzed. The author's experience with this muscle in the correction of hand deformities in leprosy is described.

Resultados da tecnica cirurgica de tranferencia do musculo fibular longo para dorsiflexao do pe equino movel em hanseniase / Transfer of the peroneus longus in footdroop deformity: results in leprosy

Este trabalho apresenta os resultados da avaliçäo da técnica cirúrgica de transferência do músculo fibular longo, descrita por Duerksen (1997), para dorsiflexäo do pé eqüino móvel realizada em 10 portadores de seqüelas de hanseníase. Estes pacientes foram submetidos a um protocolo de avaliaçäo médica e fisioterápica pré e pós-operatório por 12 semanas, com resultados que subsidiam a recomentaçäo desta técnica cirúrgica.

Manifestations articulaires, musculaires et cutanées des états réactionnels au niveau de la main du lépreux / ?

The reactional states seen in lepromatous form (erythema nodosum, leprosum, exacerbation) and i interpolar forms (tuberculoid exacerbation and tuberculoid reversal reaction) result in cutaneos, nervous, lymphatic, visceral and polyarthritic acute manifestations. The sucessif relapses result in articular, cutaneous and muscular sequelae of the hand but a paralysis of medial and ulnar nerves, often associated with leprosy, make them different from rheumatoid arthritis. They can be summarized thus: 1- Fixed claws hand associated with stiffness, erosions and sometimes subluxations of interphalangeal joints, mainly proximal and metacarpophalangeal joints...