Selection criteria for reconstructive surgery to correct mobile hand deformities in leprosy

Claw hand and z-thumb due to proximal or distal ulnar nerve paralysis, and loss of thumb opposition due to distal median nerve paralysis are the most common deformities affecting the hand in leprosy, and are among the main causes for stigma and de-habilitation. Ulnar or ulnar-median paralysis is more frequent than triple nerve paralysis (ulnar, median and radial). These deformities affect hand function, hinder the patients’ daily routine activities – 5 and restrict their social participation. – 6 Reconstructive surgery (usually with tendon transfer) aims at re-establishing the balance of forces in the hand and improving the appearance and function, thereby improving both physical abilities and social participation. Various types of tendon transfers have been described – 7 and have been shown to restore the balance of forces and the functional ability of the paralysed hand. There is wide variation in the presenting deformities due to anatomical, anthropometric, and occupational factors. These factors include the presence of secondary impairments, the strength of the long flexors and/or the donor tendon, hypermobile joints of digits, the presence or absence of palmaris longus muscles, short or long fingers, heavy or light work, and dominant or non-dominant hand. These factors should play a major role in selecting the particular type of tendon transfer which then impacts the outcome in terms of form, function and complications due to surgery. Guidelines exist for the selection of patients but they are usually restricted to the duration of deformity, age and previous medical treatment, with scant attention to other factors. – 10 For this reason, there is need for a comprehensive guideline to match the variation in the presenting deformity to the appropriate tendon transfer techniques. This would help maximise the beneficial outcome for the patient. Therefore, in this short report we present guidelines to recommend rational selection criteria for reconstructive surgery to correct claw hand and thumb deformities in leprosy.