To a general hospital

• Severe ENL reaction
• Severe side effects to drugs
• Patients with RR and complications as mentioned under “reactions”
• Wounds that need surgical debridement
• Patients requiring simple amputation.

To a hospital with surgical facilities

• Osteomyelitis of hands or feet
• Plantar ulcer that may benefit from skin grafting
• Patients requiring Syme's amputation.

To eye specialist

• Patients for lid surgery

• a lid gap of more than 5 mm on mild closure

• visibility (exposure) of the cornea on mild closure

• exposure keratitis

• lagophthalmos and corneal anaesthesia combined.

• Patients with corneal ulcer if this is not improving on treatment with an antibiotic eye ointment and eye pad

• Patients with acute iridocyclitis if this does not respond to treatment with atropine and steroids

• Patients with low visual acuity (finger counting at less than 3 meters) caused by cataract and without corneal scarring

• Patients with glaucoma.

To reconstructive surgeon

Indications for reconstructive surgery (tendon transfers) are;

• mobile claw hand
• mobile hand drop
• mobile foot drop
• mobile paralyzed thumb abduction/opposition lagophthalmos with exposure of the cornea.

Indications for cosmetic surgery are;

• nose reconstruction
• ear reconstruction
• eyebrow reconstruction.

To orthopedic workshop

• Below knee and above knee amputation
• Severe deformity of the foot which requires a plastazote boot.