rcs in leprosy
TRANSCRIPT
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Reconstructive Surgery in Leprosy
Dr. MD AKBAR KHANMS (ORTHO)
ASSISTANT PROFESSOR
A C S R Government medical college, nellore
Reconstructive Hand & Foot SurgeonDamien Foundation india trust
Nellore
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Introduction
Two important organs are damaged in leprosy The Skin The Nerves
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Pathogenesis
Mycobacterium leprae Infiltrates peripheral nerves
Destruction of Schwann cells and axons
CD4 + T-cell-mediated granulomatous process
Impairments of nerve function
Deformities in leprosy
Cascade of destructive events with intense intraneural oedema
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Affection of Nerves in Leprosy
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Sensory loss in peripheral nerves
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Lateral popliteal(common peroneal)
Facial
Radial
Posterior tibial
Ulnar
Median
Clawing of the toes & collapse of foot arches
Lagophthalmos
Wrist-drop
Clawing of Ring & little fingers Z thumb
Clawing of index & middle fingers Ape thumb
Foot-dropIntrinsic muscles of the foot
Intrinsic muscles of Hand
Paralysis of orbicularis oculi
Paralysis of thumb, fingersand wrist extensors
Paralysis of peroneal muscles & dorsiflexors of foot
Paralysis of thenar muscles
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Grip in claw hand
Normal grip Roll up Maneuver
Loss of Grasp
Grip & Grasp in Claw Hand
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Aim of Reconstructive Surgery
Augment its capabilities for the activities of daily living (ADL)
Restore form and structure adequately to accelerate the patient’s integration into society
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Selection of Patient
All deformities should be completely mobile
Patients should be motivated for surgery
Surgery according to priority: Young patients Patients with mobile claw hand Deformity - preferably one year or more. Patients with a job who are unable to
perform their jobs due to their disability or the ones who will lose their job due to the disability
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Case –1 (Ulnar Claw Hand)
Main en griffe
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Claw Hand – FDS Middle Finger
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Post op – Claw Hand
1st Week: Repeat the exercises before surgery
2nd Week: Co-ordination exercises of 2-5 fingers( Keep lumbrical position)
3rd – 4th Week: Function exercises( grasping, holding, making fist, etc.)
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Post op
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Case –2 (Ape ThumbDeformity)
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Opponensplasty – FDS Ring Finger
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Post –Op Rehabilitation
1st Week: Repeat the exercises before surgery
2nd Week: Touch the pulp of ring finger with thumb
3rd – 4th Week: Function exercises( pinching, grasping, holding, making fist, etc.)
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Case- 3 ( Foot Drop Left)
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Foot Drop – TPT Transfer
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Post –op - Foot drop
1st week: Isolate
exercise repeat the
pre-operative exercises
2nd Week: Co-ordination
exercises
3rd Week: stand up, adjust weight
4th Week: Gait exercise( face the mirror)
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After Surgery & Physiotherapy
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Case 4- Lagophthalmos
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Lagophthalmos - Temporalis
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After surgery & physiotherapy
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Case 5 :Nerve Abscess
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Neurolysis -Ulnar Nerve Abscess
Longitudinal epineurotomy
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Case 6 Gangrene Great Toe
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Supervised post-operative therapy
This is essential after all reconstructive operations
After removal of the cast suitable protective/static splinting is provided.
Post-operative re-education is provided in a staged manner, being easier for single tendon transfers.
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POP - Dynamic splints night,
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Reconstructive Surgery
GOI, GOAP & Damien Foundation India Trust
Reconstructive Surgery in Leprosy Pre-op Physio – 1 week Surgery - 1 week Splinting for - 2-3 weeks Post op physio – 1 month
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Cleyson Mupfiga HUB117 2011 31
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Cleyson Mupfiga HUB117 2011 32
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Questions ????
THANK YOU