Management of nerve abscess in leprosy

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