Surgical treatment of plantar ulcers in leprosy

Abstract

Plantar ulcers present a serious problem in the management of leprosy. After studying the mechanism of ulceration and the causes of their indolence, it appears that the treatment of the disease by antileprotic drugs is not sufficient. The underlying causes, such as anaesthesia, bony deformities and paralysis, should usually be treated by surgical means. Anaesthesia can be reversed by decompression of the posterior tibial nerve if this is done early. Deformities should be corrected by procedures on the soft tissues or bones, and chronic infection eradicated to prevent recurrence of the ulceration. A combination of procedures may sometimes be needed.

Leprosy and the anesthesiologist

“…Search of the medical literature over the past 20 yr revealed only two references on the anesthetic aspects of leprosy, 10,11 whereas a large number of such patients are being operated upon for corrective and rehabilitative procedures under different kinds of anesthesia. 12,13 This paucity of the anesthesia literature on leprosy is surprising, given that leprosy is now understood as a systemic disease affecting many organs and systems that may have direct or indirect bearing for an anesthesiologist dealing with such cases. It is difficult to determine whether this is a reflection of western literature bias or the clinical impact of leprosy to the anesthesiologist is less than anticipated from theoretical concerns.…”