[One-year follow-up of 466 nerve decompressions in 123 lepers during multidrug therapy in Madagascar]. / Résultats à un an de 466 décompressions nerveuses réalisées chez 123 lépreux en cours de polychimiotherapie à Madagascar.

Surgical decompression of nerves in patients with leprosy is a simple procedure that can be used in developing countries. At the leprosy center of Ambatoabo on the east coast of Madagascar, 466 nerve decompressions were performed on 123 subjects and results were evaluated by the same examiner 15 months later. All subjects were undergoing multidrug therapy at the time of the procedure. The decision to perform surgery was based on recent onset of sensory and motor neurologic signs and on progression or persistence of symptoms despite administration of prednisolone. Decompression led to pain relief in 100% of cases and regression of sensory disturbances in 97%. Sensory recovery in the plantar ulcers of the foot was obtained in 80% of cases and motor performance improved in 61%. These favorable results confirm the value of surgical decompression to prevent sequels of leprosy and the feasibility of this procedure in remote areas.

[Results of 466 nerve decompressions in 123 leprosy patients during polychemotherapy with a minimum follow-up of one year. Value of preventive surgery in a leprosy control program]. / Résultats de 466 décompressions nerveuses chez 123 lépreux en cours de polychimiothérapie avec un recul minimum de un an. Intérêt de la chirurgie préventive dans un programme de lutte contre la lèpre.

The clinical expression of leprosy is primarily cutaneous but its serious neurologic manifestations are maiming. Mutilations mainly of limb ends are due to peripheric nerves compression and may appear before or during the clinical treatment of the illness. Their appearance which is not automatically related to multiple Hansen's bacilli, may be prevented surgically by nervous decompression. The authors report their experiences of 466 nervous decompressions of 123 patients (89 men and 34 women), among them, 14 were pauci-bacillary and 109 multi-bacillary. They conclude that very good results (complete recovery or improvement of sensitivity, disappearing of pain) have been obtained through simple and easy-to-learn surgeries.