癩に績發する穿孔症の治療法

特に神經伸展術變法を中心にして

抄録

A reliable treatment of leprotic malum perforans has not been discovered yet. The authors conducted studies on this problem clinically and obtained score results.
The objects of present study were 11 cases of neural type and 33 cases of lepromatus type of leprosy patient, of which 36 cases were male and 8 were female cases. Neural symptoms of them were of different grades. Locations of maium perforans in the m were: toe, sohl of foot and external ankle. Nature and course of perforation were not priority taken into selection in our investigation.
Main treatment was ‘the extension of ischiatic nerve’. The treatment was performed at the 5 to 7 cm upper part of fossa poplitea (the authors' modification method). This operation were conducted one to two times in each case.
Other treatments were as follows:
1) Local treatments of maium perforans: Administration of penicillin ointment, pilocarpin ointment, chrolophyll ointment, penicillin gaze, and heftpflaster. Operation of Reverdin's skin transplantation, and sequesterotomy and application of splints.
2) Chemotherapy: Kariklein, acetocorine and anti-biotics
3) General: Bed resting.
Post-operational observing period was 3 to 12 months.
Results were as follows:
Curing period of maium perforans through this modification was generally shorter than in case of original method However, byeffect of the modification method was severer than that of original method. It may be due to the stronger extending power resulted form the modification method. Furthermore, it may affect the peroneal nerve more severly than the tibial nerve. Since almost all malum perforans are situated at the sohl of foot, the authors are intending to perform the operation of extending the tibial nerve. It is concluded that the succeeding operation should be conducted within 1 month after the initial operation, if the effect of the initial operation is not satisfactory. No correlation was found between the difference of method and rate of relapse. The ratio of recovery through the modification method is bigger than that of the original method. Incidentally, in the modification method, patients received two operations, i. e., initial and secondary operations. The ratio of relapse is higher in the former than the latter.
Relapses were hematoma, edama, excoriation, chaps of re-inflammation of local reposed infection, etc., which developed within 3 months. Therefore, if lesions were taken care of after recovery against relapses within 3 months at least, relapses n:ay be prevented.
In conclusion, according to our data, the modification method will be considered as the main treatment of leprotic malum perforans, although further improvements Ehall be made to the method.