Ulnar nerver palsy, due to leprosy, results in intrinsic muscle atrophy in the hand
which further leads to thumb web depression, hypothenar flattening and inter-digital
depression. As mush as 40 years earlier, to conceal the stigma of leprosy, patients used
to be injected with a paraffin and silicone solution in the thumb web depression and
hypothenar muscle atrophy areas. In these cases, paraffinoma eventually resulted (15∼20
years later) in recalcitrant recurrent edema and extensive inflammatory fibrosis at the
injection site. The patient then developed poor circulation resulting in permanent skin
edema and necrosis.
Six (6) patients, with paraffinoma induced ulcers on the thumb web depression and
hypothenar area, were surgically treated during the period January 1992 to October 1996
at Korean Leprosy Research Institute Hospital. One patient received distally based radial
forearm pedicle flap transfer ; three received distally based cephalic vein pedicle flap
transfer; and two patients received the Proxiderm skin traction treatment.
We have noted that distally based radial forearm pedicle flap and distally based
cephalic vein pedicle flap successfully treated the chronic ulcer and fibrosis on the
thumb web and hypothenar area of the leprosy hand. In some isolated cases, we
experienced some partial necrosis at the edge of the venous flap.
In reviewing our results, we found that the Proxiderm traction instrument proved to be
very effective in the treatment of moderate sized ulcers. We recommend that further
studies be conducted using this instrument during the treatment of paraffinoma induced
or other chronic ulcers.
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