Object ive To explore the ef fect s of di f ferent surgical methods on plantar ulcer s in leprosy. Methods The cl inical data of 71 patients with leprosy plantar ulcers and treated with different surgical methods between October 1950 and October 2006 were analyzed retrospectively. In group A, 34 cases underwent debridement, including 26 males and 8 females aged 53-88 years old (average 72.4 years old); the course of ulcer averaged 29.0 years; the size of ulcer ranged from 5 cm × 3 cm × 2 cm to 11 cm × 7 cm × 3 cm; the disabil ity degrees of the affected foot was mild in 25 cases andsevere in 9 cases according to the self-designed evaluation system. In group B, 22 cases received foot pressure rebuilding surgery, including 19 males and 3 females aged 48-83 years old (average 69.8 years old); the course of ulcer averaged 33.5 years; the size of ulcer ranged from 5 cm × 3 cm × 2 cm to 12 cm × 7 cm × 3 cm; the disabil ity degrees of the affected foot was mild in 12 cases and severe in 10 cases. In group C, 15 cases were repaired with the transposition of toe flap, foot arch flap, acrotarsium flap, or medial tibia flap, including 11 males and 4 females aged 43-73 years old (average 64.6 years old); the course of ulcer averaged 29.3 years; the size of ulcer ranged from 6 cm × 3 cm × 2 cm to 11 cm × 5 cm × 3 cm; the disabil ity degrees of the affected foot was mild in 9 cases and severe in 6 cases. No significant differences were evident among three groups in terms of the general information (P gt; 0.05), except for the difference between group A and group C on age (P lt; 0.05). Results Group A: 19 out of 34 cases healed and the average heal ing time was 46.8 days; all patients were followed up for 2-45 years (average 17.2 years); the rate of ulcer heal ing 1 year after operation was 55.9% (19/34); 12 healed ulcer patients relapsed at average 1.5 years after operation; the rate ofulcer heal ing at last follow-up was 20.6% (7/34). Group B: 18 out of 22 cases healed and the average heal ing time was 29.2 days; all patients were followed up for 2-50 years (average 13.3 years); the rate of ulcer heal ing 1 year after operation was 81.8% (18/22); 7 healed ulcer patients relapsed at average 3.3 years after operation; the rate of ulcer heal ing at last follow-up was 50.0% (11/22). Group C: 14 out of 15 cases healed and the average heal ing time was 27.1 days; all patients were followed up for 3-12 years (average 8.8 years). The rate of ulcer heal ing 1 year after operation was 93.3% (14/15); 7 healed ulcer patients relapsed at average 4 years after operation; the rate of ulcer heal ing at final follow-up was 46.7% (7/15). For the rate of ulcer heal ing 1 year after operation, there was a significant difference between group A and group B, and between group A and group C (P lt; 0.05), but no significant difference was evident between group B and group C (P gt; 0.05). For the rate of ulcer heal ing at the final follow-up visit, there was a significant difference between group A and group B (P lt; 0.05), but no significant difference was evident between group A and group C, and between group B and group C (P gt; 0.05). Conclusion The surgical treatment of plantar ulcers in leprosy should include the alleviation of the plantar high-pressure zone and the transposition of the flaps, providing good short-term and long-term therapeutic effect.
Objective To compare the long-term results andpossible complications of a modified temporalis muscle transfer(TMT) with the Johnson’s procedure in correction of paralytic lagophthalmos.Methods FromSeptember 1997 to March 2000, paralytic lagophthalmos due to leprosy in 92 patients were corrected with TMT. The 89 cases (127 to eyes including 51 unilateral and 38 bilateral) followed up 3 years after operation were analyzed. There were 69 males and 20 females with ages ranging from 18 to 65 years (52 years on average). The duration of lagophthalmos was 1-22 years with an average of 8.2 years.And 36 eyes were complicated with lower eyelid ectropion. Sixtyfive eyes were corrected with Johnson’s procedure(Johnson’s TMT group), 62 with the modified TMT procedure (modified TMT group). The modifications were as follows: ① omitting the fascial strip in the lower eyelid to avoid postoperative ectropion. ② fixing the fascial strip of the upper eyelid to the middle or inner margin of the tarsal palate depending on the degree of the lagophthalmos to avoid possible ptosis of the upper eyelid. Results In Johnson’s TMT group, the mean lid gap on light closure was reduced to 3.1 mm postoperatively from 7.7 mm preoperatively; and the mean lid gap on tight closure was reduced to 0.5 mm postoperatively from 6.1 mm preoperatively. The symptoms of redness (73.7%) and tearing(63.7%) disappeared or were improved postoperatively. However, ectropion and ptosis occurred in 24 eyes and 9 eyes respectively. The overall excellent and goodrate was 58.5%. In the modified TMT group, the mean lid gap on light closure was reduced to 3.3 mm postoperatively from 7.5 mm preoperatively; and the mean lidgap on tight closure was reduced to 0.6 mm postoperatively from 6.3 mm preoperatively. The symptoms of redness (90.9%) and tearing (71.0%) disappeared or wereimproved postoperatively, and no ectropion or ptosis was found except one ectropion. The overall excellent and good rate was 87.1%, which was significantly higher than that of Johnson’s group(Plt;0.01). Conclusion The modified TMT is an efficiency and simple procedure with very few complications, and thus is bly recommended for use when TMT is an indication.
OBJECTIVE: To determine the long-term results and possible complications of the posterior tibialis transfer in correction of the foot-drop in leprosy patients, and to compare the results by the circum-tibial and interosseous routes. METHODS: From January to October 2001, 37 cases (treated from October 1989 to October 1999) were followed up. Walking gait, active dorsiflexion and plantar flexion of the ankle joint, deformities of the feet, and patients’ satisfaction were recorded. RESULTS: Of 37 patients, 22 were treated by circum-tibial transfer, 15 by interosseous transfer. All patients’ Achilles tendons were lengthened. Excellent and good results were obtained in 30 cases (86%). The active dorsiflexion was better by interosseous route than by circum-tibial route. Out of 35 patients followed up for 2-11 years (4 years on average), 14 had talipes varus in 22 by circum-tibial transfer, 2 had talipes varus in 13 by interosseous transfer; there was significant difference between two routes (P lt; 0.05). The complications included drop-toe(5 cases), muscle atrophy (4 cases), tendon rupture (1 case) and tendon adhesion (1 case). CONCLUSION: Tibialis posterior transfer with elongation of tendo Achilles can obtain excellent results in treating foot-drop due to leprosy. Interosseous route is preferred and physiotherapy is emphasized pre- and postoperatively.
ObjectiveTo analyze the epidemiological characteristics and factors and detection ways of leprosy in Zhushan county in Hubei province, so as to provide scientific basis for developing measures to treat and prevent leprosy after basic elimination. MethodsWe summarized the detection rate, incidence and prevalence of leprosy in Zhushan county in Hubei province during 1955-2012; compared the stage when detecting leprosy, deformity/disability rates and costs according to different detection ways; and conducted descriptive epidemiological analysis. ResultsLeprosy outbreak distribution in Zhushan county in Hubei province covered 17 villages/towns, of which patients were the most in 4 southeast villages/towns. Among 123 cases of patients with leprosy, the youngest aged 4, the oldest aged 74, and the patients aged 20-39 were the most (42.28%); the sex ratio were 1.73 to 1 (male to female); most patients were peasants (83.74%); the main infection sources were family members and neighbours (45.53%, respectively); economic level, health and living condition were the main factors relevant to the prevalence of leprosy; and applying tests in people with foci contact history detected the most patients with leprosy on early stage, which caused the lowest deformity/disability rates. ConclusionWe should consistently strengthen the training of medical personnel; improve medical personnel ability of detecting leprosy; take tests for people with foci contact history and tracking as active detection ways; monitoring patients' family members as well as close contacts during 10-year latent period; and conduct timely tracking, so as to in time detect, isolate, and treat patients with leprosy, reduce the incidence of deformity/disability, and control the transition of leprosy.
ObjectivesTo analyze epidemiological characteristics of leprosy in Sichuan province from 2000 to 2017.MethodsCase data of all new leprosy patients in Sichuan province from 2000 to 2017 were collected. A retrospective analysis of its epidemiological characteristics was performed by using SPSS 19.0 software.ResultsA total of 3 208 cases of leprosy were detected during 2000 to 2017, of whom 2 197 (71.28%) were male, 885 (28.72%) were female. The younger cases whose ages were less than 14 were 82 (2.66%), and the cases with grade 2 disabilities were 614 (19.92%). The mean age of male was older than female (41.64±14.26 vs. 38.89±15.12 years, P<0.05). The grade 2 disability rate of male was significantly higher than that of female (20.94% vs. 17.40%, P<0.05). Self-report was the most common method of discovery. But the ratio of male who were detected through contact examination was significantly lower than that detected through dermatological clinic, self-report, clues check and report (the ratio of male to female was 1.57, 2.38, 2.88, 2.48, 2.37, respectively, P<0.05).ConclusionsThe case detection of leprosy declines annually in Sichuan province from 2000 to 2017, especially in high-endemic area and male patients. Female patients are younger than male patients when they are detected. The grade 2 disability situation of male patients is significantly more serious than that of female patients. Self-report is the most common way of discovery, while women are more passive.