Orthopaedic surgeon Dr Paul Brand, who has died aged 88, was the pioneer of muscle tendon-transplant operations in leprosy patients. The technique was used to restore function to paralysed hands and feet. He also studied the causes of the wasting away and shortening of fingers and toes in leprosy, and showed conclusively that this was not due primarily to the infection with the leprosy bacillus, M.Leprae, but was a secondary result of the loss of pain and temperature sensations in the hands and feet of leprosy patients, which resulted from nerve damage.
Brand's extensive research proved that numb, "anaesthetic" fingers and toes were continually liable to be injured by unnoticed trauma, burns and secondary infection. However, this could be largely prevented by the use of specially designed simple tools and shoes, and by heightening the patients' awareness of the risks.
Subsequently, he applied this knowledge to other diseases, especially to diabetes, which also caused numbness of the extremities to develop from associated peripheral nerve degeneration. Brand was so struck by the importance of pain as a protective mechanism, that he wrote a book with Philip Yancey entitled Pain - The Gift Nobody Wants (1993).
Brand's parents were missionaries, working in the hill country of south-west India. His father had designed and built their home, and also ran simple medical clinics. Brand was sent to school in London in 1923 at just nine years old. In June 1929 his father died suddenly of blackwater fever: his son had not seen him since he left home six years earlier.
On finishing school, he first trained as a builder and carpenter, which gave him a remarkable three-dimensional sense of structure and function. But he then felt called to study medicine, and entered University College Hospital Medical School, London. There he met fellow medical student, Margaret Berry, who was to become an eminent ophthalmologist, with a special interest in the eyes of leprosy patients; they married in 1943.
After qualifying in the early 1940s, Brand trained as a hand-surgeon. He worked as a surgical officer at the Great Ormond Street children's hospital, London, where he assisted at early tendon transplant operations in children suffering from poliomyelitis, and then became a surgical assistant at University College Hospital. He passed the examination for Fellowship of the Royal College of Surgeons, London, in 1945.
Brand already had a deep and deepening Christian faith, and in 1946 he was invited by Dr Robert Cochrane, an eminent leprologist and talent spotter, to return to India, to teach surgery at the Christian Medical College and hospital, Vellore, one of the best medical schools in India, with a strong Christian tradition. This invitation was to determine the future course of his life's work.
Soon after arriving there, the Brands became aware of "leprosy beggars", deformed, crippled and often blinded by the disease, which rendered them complete social outcasts. Confronted by such deep suffering and human misery, the Brands dedicated themselves to the business of relief.
It was an exciting time to undertake leprosy research. In 1943, the first successful chemotherapy treatment of leprosy was reported from the United States National Leprosarium in Carville, Louisiana, using the complicated and expensive sulphone derivative, Promin, which required intravenous injection.
Early in 1947, Cochrane courageously commenced a trial of the simple sulphone, dapsone, cheap and easy to manufacture, but hitherto considered too toxic to give to humans, first injecting it in oil subcutaneously, and later administering it by mouth. His results were excellent, and brought hope to all leprosy sufferers.
Brand was challenged to find the causes behind the terrible deformities of leprosy and even more to find effective treatment for them. For the first time, the shunned "lepers" were admitted to a general hospital for operations, and so successful was Brand that in 1952, only seven years after obtaining his FRCS, he was elected to a Hunterian professorship.
For the next 12 years, he refined his surgical techniques, developed his research on the prevention of deformity, operated and taught. The Brands returned to London in 1964, when he was appointed director of surgery and rehabilitation to the Leprosy Mission, which offered worldwide opportunities to share his life-enhancing skills. Two years later, he was seconded to the United States public health service as director of rehabilitation at Carville, where he remained until retiring in 1986.
Brand was a member of the World Health Organisation's panel of experts on leprosy, and continued to serve the Leprosy Mission International (he was president from 1993 to 1999), quietly offering wise advice. On retirement, the Brands moved to Seattle, where he became clinical professor of orthopaedics, emeritus, at the University of Washington.
Brand authored 100 scientific papers and seven books, including Clinical Mechanics Of The Hand, the premier handbook for hand surgeons, physiotherapists and other hand specialists. He was appointed CBE in 1961.
Throughout all the years, he remained humble, direct and compassionate, and these qualities came across whether he was treating a patient, operating, sitting in committee or working as a lay preacher.
Brand is survived by his wife and their six children.
· Paul Wilson Brand, orthopaedic surgeon, born July 17 1914; died July 8 2003
