Surgical interventions preventing nerve damage in leprosy patients: The role of a university hospital as a referral centre in continuing education and development of interdisciplinary programme to physical and social rehabilitation

Leprosy is one of the oldest diseases and is still considered a major public health problem in some countries. Neuropathy is the hallmark of leprosy, with Mycobacterium leprae affecting primarily skin and peripheral nerves, which results in an immunological response and leads to motor, sensory and autonomic alterations. As the result, many people experience limitation of activities of daily living, visible impairments, or simply because of the diagnosis leprosy could have restriction in society. In, there are 40.000 new registered cases each year and estimated 2.000 patients with disabilities. Despite of the adequate treatment (MDT/WHO) it is difficulty to establish the risk to develop disabilities due to nerve damage. In a pilot study, we examined 224 patients before and after MDT and found a high incidence of disabilities (64,5%). According with these results, we implemented the Leprosy Program of the Hospital in Federal University of Rio de Janeiro. The aim of this study is to discuss the experience of surgical approach (surgical decompression and tendon transfers) as a method of prevention of nerve damage and impairment in leprosy from 1998 to 2008. The role of an interdisciplinary staff (dermatologist, orthopedics surgeons, physiotherapists and social service) in this program is also presented.  In this period 104 surgical interventions were performed, including nerve decompression (ulnar, median, tibial and peroneal), tendon transfers (drop foot and claw hands) and arthrodesis. Being a reference hospital in, we promoted the propagation of these techniques in 2 workshops, training 60 new professionals, performing 50 surgical procedures and examining the patient’s evolution in periodical clinical sessions. This study point out the role of referral centers, as University Hospital, in diffusing new techniques (continuing education), training and stimulate the interdisciplinary relation of health professionals to treat nerve damage impairment and promote quality of life in leprosy patients.