| Background & Objectives: Pure neuritic Hansen’s disease (PNHD) can present with neuropathy in the absence of visible skin lesions, making diagnosis challenging. Nerve biopsy remains a critical diagnostic tool when clinical evaluation and slit-skin smears are inconclusive. This abstract aims to describe the techniques, safety considerations, and diagnostic utility of ulnar and sural nerve biopsies in PNHD. Methods: Nerve biopsies target purely sensory branches to minimize motor deficits. For the ulnar cutaneous nerve, a longitudinal incision of 3–4 cm is made over the dorso-medial aspect of the hand, distal to the wrist, along the dorsal branch. The nerve is identified as a glistening white cord, carefully dissected, and approximately 2 cm of nerve is isolated with minimal handling to prevent crush artefact. For the sural nerve, a 4–5 cm incision is placed over the dorsolateral distal leg, posterior to the lateral malleolus. Similar care is taken to isolate 2 cm of nerve. In both techniques, impression smears are prepared from cut edges for modified Ziehl–Neelsen staining. Proximal and distal ends are buried before closure, and the wound is closed with simple interrupted sutures. Specimens are divided, with portions preserved in ethanol for polymerase chain reaction (PCR) and formalin for histopathology, alongside any skin sample taken. Results: When performed with meticulous technique, nerve biopsies provide adequate tissue for histopathology, PCR, and smear studies while minimizing complications. Sensory impairment is usually mild and localized, with motor function preserved. Proper haemostasis, gentle handling, and correct specimen length reduce the risk of hematoma, neuroma, or wound infection. Conclusions: Ulnar and sural nerve biopsies are safe, reliable, and complementary techniques for diagnosing PNHD. Careful dissection of purely sensory nerves optimizes diagnostic yield and minimizes functional complications. Mastery of these techniques is essential for clinicians managing patients with PNHD, particularly when other diagnostic modalities are inconclusive. |
