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Journal of Bone and Joint Surgery - British Volume, Vol 90-B, Issue 2, 220-224.
doi: 10.1302/0301-620X.90B2.19586  
Copyright © 2008 by British Editorial Society of Bone and Joint Surgery
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Nerve repair by denatured muscle autografts promotes sustained sensory recovery in leprosy

J. H. Pereira, MD, FRCS, Consultant Surgeon, Honorary Senior Lecturer1; D. D. Palande, MS, Consultant Orthopaedic Surgeon (Retired)2; T. S. Narayanakumar, MS, Consultant Hand Surgeon2; A. S. Subramanian, DOrth, Medical Superintendent2; S. Gschmeissner, BSc(Hons), Chief Scientific Officer (Retired)3; and M. Wilkinson, MRCPath, Consultant Pathologist, Honorary Senior Lecturer4

1 James Paget University Hospital NHS Foundation Trust, Lowestoft Road, Gorleston, Great Yarmouth, Norfolk NR31 6LA, UK.
2 Sacred Heart Leprosy Centre, Karaikal Road, Kumbakonan, Thanjauur district, Tamil Nadu, India.
3 Cancer Research UK, Lincoln’s Inn Fields, London WC2 3PN, UK.
4 University of East Anglia Medical School, Norwich, NR4 7JJ, UK.

Correspondence should be sent to Mr J. H. Pereira; e-mail: jerome.pereira{at}jpaget.nhs.uk

A total of 38 patients with leprosy and localised nerve damage (11 median at the wrist and 37 posterior tibial at the ankle) were treated by 48 freeze-thawed skeletal muscle autografts ranging between 2.5 cm and 14 cm in length. Sensory recovery was noted in 34 patients (89%) and was maintained during a mean period of follow-up of 12.6 years (4 to 14). After grafting the median nerve all patients remained free of ulcers and blisters, ten demonstrated perception of texture and eight recognised weighted pins. In the posterior tibial nerve group, 24 of 30 repairs (80%) resulted in improved healing of the ulcers and 26 (87%) demonstrated discrimination of texture. Quality of life and hand and foot questionnaires showed improvement; the activities of daily living scores improved in six of seven after operations on the hand, and in 14 of 22 after procedures on the foot. Another benefit was subjective improvement in the opposite limb, probably because of the protective effect of better function in the operated side. This study demonstrates that nerve/muscle interposition grafting in leprosy results in consistent sensory recovery and high levels of patient satisfaction. Ten of 11 patients with hand operations and 22 of 25 with procedures to the foot showed sensory recovery in at least one modality.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General