Introduction

Leprosy, or Hansen’s disease, is a chronic infectious condition caused by Mycobacterium leprae, primarily affecting the skin and peripheral nerves. Although it is curable with multidrug therapy (MDT), many patients are left with lasting disabilities due to delayed diagnosis or nerve damage that occurs before or during treatment. These impairments most commonly affect the hands, feet, and face.¹ 

These are not caused directly by the bacteria, but by the loss of sensation and muscle control, which can lead to injuries, infections, and deformities over time, intensifying the condition.²

Surgical intervention plays a critical role in managing these complications. While medications halt disease progression, surgery helps restore physical function, improve appearance, and enhance quality of life.³ In many cases, surgical correction is key to enabling patients to regain independence and reintegrate into their communities. This article explores the range of surgical options available for managing leprosy-related disabilities, outlining their purpose, procedures, and the impact on patients’ lives.

Understanding leprosy-related deformities 

Leprosy mostly hurts peripheral nerves. This causes nerve harm that gets worse over time if not diagnosed soon. Harm to the body comes from nerve impairment.¹ This leads to loss of sensation, muscle weakness, and paralysis, mostly in the hands, feet, and face. These changes are made worse by other hurts, like burns or cuts, that are not felt due to loss of feeling.

Body changes from leprosy are put into two groups: paralytic and non-paralytic. Paralytic deformities come from harm to motor nerves. This causes conditions like claw hand (ulnar and median nerve palsy), foot drop (common peroneal nerve palsy), and lagophthalmos (facial nerve palsy), which makes it hard to close the eyes.³

Non-paralytic deformities come from repeated injuries and poor healing of wounds. They include plantar ulcers, absorption of fingers or toes, and nasal collapse.

More than just harm to the body, these changes can lead to stigma, being left out, and deep worry. People with leprosy often find it hard to get a job, go to school, or take part in activities with others, even after their medical care is done.  Knowing the cause of this harm is important for surgery at the right time and for care.

Goals of surgical intervention

The main goal of leprosy surgery is to restore function and prevent further damage, rather than simply improving appearance.⁴ It is often needed when nerve damage causes serious problems with movement, sensation, or the structure of the hands, feet, or face. Key goals are:

• Functional restoration: Procedures like tendon transfers or nerve decompressions aim to recover the ability to grip, walk, or close the eyes
• Prevention of complications: Surgical correction can reduce the risk of ulcers, contractures, and further deformity³
• Cosmetic improvement: Particularly in facial deformities, surgery helps improve appearance and reduce stigma⁴
• Psychosocial rehabilitation: Regaining mobility and normal appearance enhances self-esteem and social integration
• Support for rehabilitation: Surgery often complements physiotherapy, occupational therapy, and the provision of assistive devices⁴

Surgical interventions by site

Surgical management in leprosy is tailored to the site and type of deformity.⁵ It typically involves functional reconstruction, which is most commonly through tendon transfers. In some cases, decompression of compressed nerves. The aim is to improve movement, sensation, and prevent further injury or disability.

 Hands

The hands are among the most commonly affected areas in leprosy due to ulnar and median nerve damage.⁶ This often leads to claw hand deformity; The fingers bend back at the big joints and curl in, which makes it hard to hold things.⁷ Tendon transfer surgery is used to help fingers open and grip. One commonly used technique is the Zancolli lasso procedure, which helps functioning tendons to balance finger movement.⁸ In cases of loss of thumb opposition, a surgery like opponensplasty is done. 

After surgery, splinting and physiotherapy are highly recommended. This helps muscles learn again and stops them from getting stiff.

Feet

A common associated condition is foot drop. It happens when a nerve is hurt. You can't lift your foot when you walk. This makes you less steady. It puts you at risk for falls and foot sores. This causes instability and increases the risk of falls and foot injuries. The most common surgery to fix this is the posterior tibial tendon transfer. It moves a good tendon to help lift the foot. In severe cases where infection or damage is extensive, amputation followed by fitting of a prosthesis may be necessary. 

Face

Facial nerve involvement can lead to lagophthalmos, which is the inability to fully close the eyelids. This exposes the eye to injury, dryness, and infection.⁹ Surgery can help protect the eyes. One option is partially stitching the eyelids together (tarsorrhaphy). Another is placing a small gold or platinum weight in the upper eyelid, so it closes naturally using gravity. If facial muscles are weak or paralysed, muscle transfer surgery, such as moving the nearby temporalis muscle. This can help bring back some facial movement, like smiling.

Leprosy can also cause nasal collapse (a flat nose) when the tissue around the nose is damaged.¹⁰ This can be treated through nose reconstruction surgery (rhinoplasty) to rebuild the nose and improve breathing.

Nerve decompression

Sometimes, nerves become swollen or trapped due to leprosy. This can cause pain, tingling, or weakness in the hands or feet. Nerve decompression surgery helps by releasing pressure on the affected nerve.⁵ Common places where this surgery is done include the ulnar nerve at the elbow, the median nerve at the wrist, and the posterior tibial nerve at the ankle. The surgeon removes tight tissue pressing on the nerve to help it work better.

This type of surgery works best when done early, before the nerve is badly damaged. It can help stop further loss of movement or feeling and may improve symptoms.

Timing and candidacy for surgery

Surgery for leprosy-related problems should be done at the right time; usually after the infection has been treated and inflammation has settled.¹¹ This reduces the risk of complications and helps ensure better healing.

Before surgery, doctors assess:

• How much function is lost
• Which nerves are affected
• Whether the patient is healthy enough for surgery
• The patient’s expectations and goals

Surgery can greatly improve movement, independence, and quality of life. It's part of a larger care plan that includes therapy, education, and long-term support.

Post-operative care and rehabilitation

Recovery after surgery is just as important as the surgery itself. Patients need regular physiotherapy to strengthen muscles, splints to support healing, and training to learn how to use their hands or feet again.¹²

• Rehabilitation includes simple exercises, walking aids, or custom shoes to prevent new injuries
• Occupational therapy helps patients return to daily tasks like eating, writing, or working
• Emotional support and counselling may also be offered, especially for people who’ve faced stigma or isolation

Follow-up care ensures that wounds heal properly and helps manage any new problems early. With good post-surgical support, many people regain their independence and confidence.

Outcomes and real-life impact

Surgery can make a big difference in the lives of people affected by leprosy.³ By restoring movement or closing open wounds, it helps people walk, work, and care for themselves again. Many also feel more confident and accepted after surgery, especially if visible deformities are corrected.¹²

Where care is available, results are often positive, especially when surgery is combined with therapy and support. Patients often report better mobility, fewer injuries, less pain, and a stronger sense of independence and self-worth.

Conclusion and key takeaways

Surgery for leprosy-related deformities is about restoring function and dignity, not just improving appearance. When done at the right time and followed by good care, it can greatly improve how a person moves, works, and feels about themselves. While curing the infection is important, surgery helps repair the damage it leaves behind. With skilled surgeons, rehab teams, and patient support, people affected by leprosy can regain control of their lives.