The promise of surgery, its scope and limitations in leprosy.

Leprosy is a systemic disease mainly manifested in skin and nerves. The nerves affected are the cutaneous and trunk nerves, especially those located superficially. Early treatment of the disease prevents deformity or disability. Otherwise, the continuing disease process and immune reaction, either by direct involvement of tissues or secondarily through destruction of some trunk nerves, results in deformities and disabilities. All of these complications are amenable to surgical treatment, the results being excellent when the surgery is performed early. To a deformed patient, appearance means the difference between being an outcast and a normal life in the community. To leprosy control programmes, surgical treatment means the possibility of offering a comprehensive treatment to those cases needing more than chemotherapy. For this reason, surgery is an important part of leprosy treatment and should be available to all control programmes. Health Education (HE) and Prevention of Disabilities (POD) are also essential activities to all leprosy control programmes. Although these activities show a more adequate cost! benefit ratio, surgery should also be regarded as a preventive measure. As examples, surgical correction of drop foot prevents the onset of distorted foot and ulcers in the lateral border which usually leads to a total destruction of the foot. Appropriate surgical correction of clawed hands prevents rigidity of small joints in the affected hand and also improves the grasp, reducing the possibility of wounds in finger tips which, otherwise, would lead to a grossly deformed and useless hand.