[The value of the medial plantar flap in the repair of loss of soft tissue in the distal quarter of the leg]. / Intérêt du lambeau plantaire médial dans la réparation des pertes de substance du quart distal de la jambe.

OBJECTIVE: Soft tissue repair of the distal leg is a challenge for the surgeon. The objective of our work is to evaluate the interest of medial plantar flaps in the repair of soft tissue loss in the distal quarter of the leg, by highlighting the advantages and disadvantages of this technique. METHODS: We conducted a retrospective study over 4 years in the Department of Plastic, Reconstructive and Burn Surgery of the Mohammed V Military Teaching Hospital of Rabat, including 8 patients admitted for coverage of a distal quarter of the leg with a medial plantar flap. RESULTS: Eight patients were included, 5 men and 3 women with an average age of 45.5 years. All patients received coverage with a medial plantar flap. The functional and aesthetic results were very good with a low complication rate. CONCLUSION: The medial plantar flap should no longer be reserved for covering loss of substance of the foot only, but should be integrated into the therapeutic arsenal of reconstruction of the distal quarter of the leg.

Brûlures électriques des extrémités: devons nous amputer en urgence?

High voltage electrical burns constitute serious injury. Their depth increases over time. They lead to major tissue damage, sometimes irreversible, with tremendous functional and aesthetic sequelae, especially when extremities are involved.1 In emergency settings, the plastic surgeon faces a dilemma: should he amputate the burnt extremity immediately in order to avoid rhabdomyolysis, or wait until necrosis is delimited to avoid multiple surgeries and limit the size of amputation?

[Cardiocirculatory arrest caused by electric shock: importance of semi-automatic defibrillator]. / Arrêt cardiocirculatoire par accidents d'électrisations: intérêt du défibrillateur semi-automatique.

Accidental electrical burn injuries are serious because they can cause death by cardiocirculatory arrest. Cardiocirculatory arrest induced by low-voltage current is generally due to ventricular fibrillation, and the prognosis is fairly good if the survival chain is efficient. It is necessary to give priority to early defibrillation using an automated external defibrillator. Early defibrillation can immediately restore spontaneous circulation.

[Rail plastic surgery technique in the treatment of popliteal contractures]. / La plastie en rail dans le traitement des brides rétractiles du creux poplite.

The case is presented of a patient aged 45 years suffering from thermal burns due to flame following the deflagration of a gas cylinder. The initial lesions involved the four limbs, in particular the knee, and the trunk. The initial taking in charge consisted in an early excision-graft of the limbs. The evolution of the burn was marked by the development of hypertrophic scars at the level of the non-transplanted zones and at the edge of the graft as also by the onset of contractures. Because of the functional problem caused by the contracture as a result of the considerably reduced extension, the patient was admitted for surgical treatment. Thanks to the rail technique described, the patient recovered normal knee function. Post-surgical treatment was straightforward with a hospitalization period of one month. The aesthetic results were satisfactory. The rail technique is part of the therapeutic arsenal for treating knee contractures. Its simplicity, easy technique, and satisfactory results, plus its easy follow-up, make it a highly appreciated technique in the treatment of this type of contracture.

Epidemiological analysis of burn patients in the military hospital, Rabat, Morocco.

A retrospective study was conducted of burn patients admitted to the military hospital in Rabat, Morocco, in the 6-yr period from 2004 to 2009. This is the first multivariate study to be performed in Morocco. The epidemiological data from the 291 patients hospitalized were collected and studied. The type of burn was indicated in 284 of the patients: 94% of the injuries were thermal burns, 4% were electrical burns, and 1.5% chemical burns. In 261 cases the exact aetiology was noted: 56% of accidents were caused by flames, 38% by hot liquids, 4% by electric current, and 2% by chemicals. The distribution of the Moroccan population is as follows: 0-4 yr, 7%; 5-l4 yr, 8%; 15-19 yr, 8%; 20-59 yr, 70%; over 60 yr, 7%. The male/female sex ratio was 1.63. The mean duration of hospitalization stay was 42 ± 62 days. The mean body surface area burned was 21 ± 18%. Total mortality was 5%; 57% of deaths were due to septic shock. Our results were similar to data from other studies in the literature, with certain characteristics in our series, especially the age bracket most affected, the body surface area burned, and the mechanisms of injury.

[The Ogilvie syndrome in a severely burned patient]. / Le syndrome d'ogilvie chez le brule grave.

The Ogilvie syndrome is an acute colonic dilatation of the previously healthy colon, without any organic obstruction. Pathological circumstances such as burns and antipsychotic medication have been identified as predisposing elements. The incidence of this complication, in the reanimation of burn patients, varies between 0.5 to 1%. The purpose of our study is to draw attention to the Ogilvie symptom by describing a case with its clinical and paraclinical data, its physiopathological causes, and the therapeutic aspects. The clinical picture in our patient was characteristic: extensive abdominal meteorism. The abdominal scan showed massive colonic dilatation without any mechanical obstacles. The outcome was successful after colonoscopic exsufflation. The Ogilvie syndrome is a rare occurrence which without effective treatment may result in caecal perforation and a poor prognosis. It is therefore necessary to establish the diagnosis early and, in particular, to initiate close radiological follow-up after the establishment of medical treatment, in which colonoscopy plays an important part.

[Burns by electric scalpel blade: four cases]. / Brulure par Plaque de Bistouri Electrique: a Propos de Quatre Cas.

A burn due to the plate of a diathermy knife is a rare but serious accident owing to the depth of the lesion and its localization, especially when it occurs in a surgical context that creates difficulties for both the patient and the surgeon. Such burns are unpredictable and also serious not only because of their location but also because they occur during a surgical operation in patients who are already ill. Such burns have to be dealt with by specialists. Prevention is the only way of avoiding this kind of accident.

[Münchausen syndrome by proxy. A case report]. / Le syndrome de Münchausen par procuration. A propos d'un cas.

The plastic surgeon rarely encounters patients with factitious disorders. The syndrome of Münchausen by proxy is a part of it. We put the point on this syndrome through a clinical observation of an eight-year-old girl victim of parental abuse.

[Not Available]. / La Prise en Charge des Brulures Electriques: a Propos de 30 Cas.

Les brûlures électriques sont rares mais graves nécessitant une prise en charge urgente et adéquate car l'évolution peut être émaillée de complications graves, notamment cardiaques, neurologiques et rénales, et les séquelles sont importantes. A travers une étude analytique et rétrospective de janvier 2000 à novembre 2007 ayant inclus 30 patients admis au Service des Brûlés de l'Hôpital Militaire d'Instruction Mohamed V de Rabat, Maroc, pour prise en charge de brûlures électriques, il a été relaté les mécanismes des brûlures électriques, comme aussi les complications, la morbidité et la mortalité, dues aux brûlures électriques, tout en insistant sur les modalités de prise en charge initiale chez ces patients. La prévention reste le point capital pour réduire l'incidence de ces accidents. Cette prévention se base sur la surveillance des enfants et l'élimination de facteurs de risque à la maison, par la maintenance des installations électriques et par l'information et l'éducation du public.

[Not Available]. / Brulures par Bouillottes Chez les Diabetiques.

Diabetic neuropathy is a frequent complication of diabetes. The most frequent clinical form is known as "sock polyneuritis", with loss of sensitivity to pain in the feet. Hot water bottle burns are the prerogative of diabetic patients suffering from a form of sensitive polyneuropathy. Such burns are deep. It is difficult to take therapeutic responsibility and decisions must be multidisciplinary. We underline the importance of the education of diabetic patients and of arousing their awareness to the possible risks involved in the use of hot water bottles.

[Not Available]. / Prise en Charge du Syndrome de Lyell ou Necrolyse Epidermique Toxique.

Le syndrome de Lyell ou nécrolyse épidermique toxique (NET) est une pathologie très grave des dermatoses bulleuses d'étiologie médicamenteuse. Il se caractérise par une nécrose aiguë de l'épiderme sur toute la hauteur du corps muqueux. L'aspect clinique de la NET est celui d'une brûlure étendue du deuxième degré profond. A ce tableau s'associent constamment des lésions muqueuses et une atteinte multiviscérale qui aggrave le pronostic. Nous rapportons deux cas de NET qui illustrent l'importance d'une prise en charge précoce et multidisciplinaire de ces patients atteints au sein d'un service de réanimation des brûlés, dont les fondements reposent sur l'asepsie rigoureuse, l'apport hydroélectrolytique et nutritionnel, la prévention de l'infection et son traitement par une antibiothérapie adaptée, et un nursing et des soins locaux. L'efficacité supposée des immunoglobulines intraveineuses ne repose que sur des cas isolés et il n'y a pas encore d'études randomisées.

[Not Available]. / Le Point sur la Pharmacologie des Agents Anesthesiques Chez le Brule Grave.

La pharmacologie des agents anesthésiques chez le brûlé est variable et imprévisible. Dans les premières 48 h, il y a une hypovolémie avec chute du débit cardiaque et des fuites plasmatiques. Après 48 h, il y a une hypervolémie avec augmentation du débit cardiaque, hypermétabolisme et la clearance des médicaments est augmentée. Parmi les facteurs de déséquilibre, on retrouve les variations des protéines plasmatiques. Deux protéines sont importantes chez le brûlé grave : l'albumine et l'alpha 1- glycoprotéine. Leur taux varie beaucoup au cours de l'évolution de la brûlure. Les agents anesthésiques dont la liaison avec ces deux protéines est prédominante verront leur pharmacocinétique modifiée. L'anesthésiste-réanimateur du service des brûlés va maîtriser ces notions pharmacologiques pour utiliser à bon escient les agents anesthésiques.

[Not Available]. / L'Attitude Chirurgicale dans les Brulures Electriques Graves par Haut Voltage: À Propos de Deux Cas.

Devant une brûlure électrique grave, deux attitudes chirurgicales se distinguent: 1. une attitude conservatrice; 2. une attitude d'amputation. A la lumière de deux observations, les Auteurs discutent les avantages et les difficultés de la mise en oeuvre de chaque attitude.

[Not Available]. / Les Hemorragies Gastroduodenales de Stress Chez le Brule Grave.

Les Auteurs rapportent trois observations d'hémorragies gastroduodénales de stress chez le brûlé grave. Ils rappellent l'importance des mesures thérapeutiques qui doivent être prises chez le brûlé grave, comme le traitement du choc, du sepsis, des plaies et de la douleur, la nutrition entérale précoce et l'oxygénothérapie. Tout cela permet de réduire les facteurs de risque de survenue d'une hémorragie gastroduodénale de stress.

[Not Available]. / Intubation Difficile Chez le Brule de la Face et du Cou a la Phase de Sequelles.

L'intubation trachéale chez le brûlé de la face et du cou au stade de séquelles peut être difficile voire impossible chez certains patients. La technique de ventilation à l'aide d'un masque laryngé ou d'intubation avec un fibroscope bronchique permet de résoudre la plupart des problèmes d'intubation difficile. Les Auteurs rapportent deux observations chez deux patientes porteuses de séquelles de brûlures de la face et du cou.

[Myocardial rhabdomyolysis following paraphenylene diamine poisoning]. / Rhabdomyolyse du myocarde après intoxication par la paraphénylène diamine.

Acute intoxication with paraphenylene diamine, a mineral compound used as hair dye, associated asphyxia due to cervical oedema and rhabdomyolysis. We report the case of a patient with lethal cardiogenic shock secondary to myocardial rhabdomyolysis confirmed by a postmortem biopsy.