RESEARCH

RESTORATION OF SENSATION IN LEPROSY

This is being achieved at this centre in two ways depending on the duration of loss of sensation.

1. Within six months of loss of sensation medical treatment or surgical decompression when indicated restores the sensation in majority of cases.  Many papers have been published from this institution on this subject.

2. After one year of paralysis of a trunk nerve, the nerve does not recover its function.  In these cases excision of the diseased portion of the nerve and its replacement by an autologous skeletal muscle graft has shown appreciable sensory recovery in nearly 50% of cases (research results to be published).

The background of this research is:

The technique of using muscle graft replacing diseased or injured segments of peripheral nerves in animal experiments at Royal College of Surgeons of England, produced successful results. (Pereira et al,  JBJS, 1990).

The technique was found to be successful in the repair of digital nerves in humans and comparison of this technique with conventional end to end suturing repair showed superior results (Pereira et al, International Journal of Hand Surgery – 1991).

Previous studies of nerve muscle grafting at both Sacred Heart Leprosy Centre, Kumbakonam, India and at ALERT, Addis Ababa, Ethiopia, have shown some recovery of nerve function although in no case has the functional recovery approached normality.  In the majority of cases, there was some useful recovery of sensation.

The recovery of sensation, even though observed in a few cases two years after operation, continues to improve slowly and in some cases take five years to manifest.  There is reduced occurrence of plantar ulcers and these patients start sensing the surfaces as they walk on stones, pebbles etc.   Better results are noted in median than in posterior tibial nerves.

A new research project is planned aimed at restoration of sensation by operating in patients with a shorter duration of paralysis and the disease.

All these projects have been fully supported and funded by LEPRA (U.K. and INDIA).  We are thankful for the active and consistent collaboration of Dr.Jerome H.Pereira, Dr.Dinkar D.Palande and Dr.T.S.Narayanakumar.  Also we are especially thankful to Prof.Bowden and Prof.J.L.Turk, from the Royal College of Surgeons of England who gave us active support.