title: Treatment of Peripheral Neuropathy in Leprosy: The Case for Nerve Decompression.
abstract: Plastic surgery has a tradition of caring for patients with facial deformity and hand deformity related to leprosy. The approach, however, to the progressive deformity and disability related to chronic nerve compression is underappreciated in the world today. A cohort of patients with leprous neuropathy from an indigenous area of leprosy in Ecuador was evaluated for the presence of chronic peripheral nerve compression, and 12 patients were chosen for simultaneous upper and lower extremity, unilateral, nerve decompression at multiple levels along the course of each nerve. The results at 1 year of follow-up show that 6 patients improved into the excellent category and 4 patients improved into the good category for improved function. Based on the early results in this small cohort of patients with leprous neuropathy, an approach to peripheral nerve decompression, encompassing the concept of multiple crush at multiple levels of each nerve, seems to offer optimism to improve upper and lower extremity limb function. Long-term studies with quality-of-life outcomes would be welcome.
authors.affiliation: Department of Plastic Surgery, Johns Hopkins University, Baltimore, MD; Department of Plastic Surgery, Luis Vernaza Hospital, Guayaquil, Ecuador; and Damien House Organization, Guayaquil, Ecuador.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Wan
authors.affiliation: Department of Plastic Surgery, Johns Hopkins University, Baltimore, MD; Department of Plastic Surgery, Luis Vernaza Hospital, Guayaquil, Ecuador; and Damien House Organization, Guayaquil, Ecuador.
authors.forename: Andres F
authors.initials: AF
authors.lastname: Rivadeneira
authors.affiliation: Department of Plastic Surgery, Johns Hopkins University, Baltimore, MD; Department of Plastic Surgery, Luis Vernaza Hospital, Guayaquil, Ecuador; and Damien House Organization, Guayaquil, Ecuador.
authors.forename: Renato Martinez
authors.initials: RM
authors.lastname: Jouvin
authors.affiliation: Department of Plastic Surgery, Johns Hopkins University, Baltimore, MD; Department of Plastic Surgery, Luis Vernaza Hospital, Guayaquil, Ecuador; and Damien House Organization, Guayaquil, Ecuador.
authors.forename: A Lee
authors.initials: AL
authors.lastname: Dellon