Leprosy
Mailing List, August 27th, 2008
Ref.: Management of nerve
abscess in leprosy.
From: Salafia
A.,
Mumbai
,
India
Dear
Salvatore,
I refer to Dr
Ranthilaka Ranawaka’s message dated LML Aug. 25th, 2008
about management of multiple nerve abscesses in leprosy. This
is my view and what I have done in about 2500 nerve explored, out of
which more than 500 where nerve abscesses. Multiple nerve abscesses are
not rare at all.
All nerve abscesses have to be excised. Somebody has even said to leave
a nerve abscess alone; now this is contrary to the principles of any good
surgery. The fact is: whenever there is an abscess, there is
also a certain amount of oedema, so if you give only steroids, the
abscess seems to reduce and you are happy about it; but steroids will
reduce only the oedema component; the abscess will remain; and if it
not excised, two things may happen:
(1)
if the abscess is close to the skin, it will lead to a sinus (I have
seen quite a few);
(2)
if it is deep, it will spread by contiguity to other structures and,
sooner or later some more abscesses will appear.
Practically: you can give a brachial block and explore the nerve as
far as you can; excise the abscess, taking care not to leave any
necrotic tissue behind. I
would suggest you take the help of a Hand Surgeon or a Plastic Surgeon
as it appears that you need to do an extensive dissection.
Antibiotic treatment is given, for example a good injectable
antibiotic like Ceftriazone. Two-three days after surgery, it is
advisable to put the patient on high dosages of steroids in order to
reduce the inflammatory process which may lead to adhesions.
Good luck.
Antonio Salafia
Hand surgeon
Head
of Reconstructive
Surgery
Vimala
Hospital
Mumbai
India
