[Epidemiologic concept of the prevention of leprous mutilations and surgery].

The frequency of mutilations reaches about 20% to 30% of the tuberculoid or borderline forms owing to the evolution of leprosy neuritis and their aggravation when leprosy reactions occur. In fact, the determinant cause is the loss of sensitivity of the extremities, as a result of internal compression of nervous bundles, which is increased by traumas in articular movements, and mainly by the external compression in the bony canals, in hypertrophic neuritis. There are many propitious causes: exposure of the extremities to traumas which are related either to crafts or to walk, or to occupational traumas, and which are worsened by deformations and subacute infection. In intractable neuritis, hygiene, protection from traumas of the extremities (especially of the feet), treatment of paralyses, resection of bony prominences, in order to distribute pressions more equally, in spite of such care, only will be able to delay supervening of mutilations. The best technique of prevention is represented by early diagnosis and early treatment of leprosy and neuritis, for which retrospective epidemiological investigations should be carried out, in order to apply identifying the risk factors.