[Pilonidal cyst of the scalp following a single minor trauma]. / Kyste pilonidal du scalp secondaire à un traumatisme inaperçu : à propos d'un cas.

The pilonidal cyst is an inflammatory disease occurring when a hair follicle penetrates inside a surgical wound. Uncommon in the scalp region, the pilonidal sinus is typically encountered in the sacrococcygeal regions. A single minor trauma of the scalp can be an inductor factor. The surgical treatment includes one-piece excision of the cyst followed by direct closure. We report a case of a 4-year-old child presenting a pilonidal sinus of the scalp following a single minor trauma.

Traitement Chirurgical Des Brides Cervicales Post Brûlure: À Propos De 47 Cas.

When their treatment is not optimal, deep cervical burns often develop retractions, ranging between simple vertical retractions to major global ones. They generate functional, aesthetic and psychological sequelae. Surgical treatment, adapted to both the patient and the type of retraction, has several goals including restoring the neck-chin angle, restoring a correct aesthetic aspect, and allowing social rehabilitation. In our unit, we managed 47 patients (mean age 22) with neck contractures over 8 years, from 2012-2020. Scald is more frequent in children while flame burns prevail in adults. Most (58%) patients healed spontaneously. Moderate and severe contractures (Achauer's classification) accounted for 30.6 and 38.8% respectively. In most (94%) patients, the contracture leads to a distortion of the neck-chin angle and limits the extension of the neck. Surgery techniques were skin grafts (67.3%), local plasties (24.5%) and flaps (8.2%). During the follow-up, results were considered as good in 83%, acceptable in 8.5%, while 8.5% needed another surgery. Plasties (Z, IC, VY…) and local flaps (with or without skin expansions) are indicated in minor contractures. Authors still debate on the best technique (graft or flap) for severe and major ones. Post-operative rehabilitation is a cornerstone for good results.

Brûlure Par Foudre: A Propos D'Un Cas.

Lightning strikes are infrequent but possibly deadly incidents. Their consequences on the human body vary and are still little known. Cardiac arrest is the main cause of death. Neurological and psychological sequelae should systematically be looked for. The most frequently reported signs are Lichtenberg figures and keronauparalysis. Care of a victim of a strike mainly depends on first aid. We found only case reports in the literature. We report here another case and discuss it including a literature review.

A Moroccan plastic surgery department approach during COVID-19 pandemic.

COVID-19 pandemic is an obstacle for all health systems, especially in African countries. This paper shows how plastic surgery teams can adapt human resources and an efficient approach to provide the best care to our patients in this troubled time.

The Cost Of Acute Burn Patients Treated In A Moroccan Intensive Burn Care Unit.

Eighty-five percent of burns occur in low- and middle-income countries, but reports on the cost of burn treatment in these countries are still rare. It is important for patients, their families, the government, society and insurance companies to be aware of the costs of burn treatment. Burn care in specialized burn units requires trained doctors and staff, specialist equipment, facilities, special tissue banks and specific dressings, and is thus very expensive. Burn care in Morocco is not as expensive as in other countries but nonetheless proves to be a high financial burden for patients, their families and the wider society. In this report we comprehensively calculate almost all the direct costs of managing in-hospital acute burns. The mean burn cost per patient in our country is US$ 16 975. We also compare the results of treatment with other reports. In this way, governmental and burn hospital authorities can have a better estimation of the direct costs of a burn center and the total budget that may be required for the whole country to cover the annual costs of treating burn patients.

Alors que 95% des brûlures surviennent dans les pays à IDH bas ou moyen, les données concernant le coût de leur prise en charge restent rares. Il est important pour les patients, leurs familles, les gouvernements et les sociétés d'assurance de connaître ce paramètre. Les soins aux brûlés dans les unités spécialisées nécessitent du personnel médical et non médical qualifié, des infrastructures, des équipements et du matériel spécifiques, une banque de peau, investissements très lourds. Bien que moins chère que dans d'autres pays, la prise en charge des brûlés au Maroc représente une charge financière importante pour les patients, leur famille, la société entière. Nous avons calculé la quasi- totalité des coûts directs d'une hospitalisation en service de soins intensifs aux brûlés, qui est en moyenne de 16 975$ et l'avons comparé aux données de la littérature. Ceci permet au gouvernement et aux directeurs d'hôpitaux de modéliser le budget nécessaire au fonctionnement d'un centre de traitement des brûlés, afin de l'abonder et de prévoir l'enveloppe nécessaire à la prise en charge des brûlés à l'échelle du pays.

Apport du facteur de croissance épidermique humain recombinant injecté en intra- lésionnel dans le traitement des plaies chroniques.

The use of recombinant human factor in intralesional diabetic foot has been the subject of several studies that have proven its effectiveness, to the extent of avoiding amputation. Its effectiveness on chronic wounds is currently being studied, with relevant results. We analyzed the results of a series of patients with chronic wounds treated in the Plastic Surgery Department of the Mohammed VI Medical Center in Marrakech. This is a prospective study conducted between January and April 2019, involving ten patients with chronic wounds, who benefited from intra- and peri-lesional infiltration of recombinant human factor. The average age was 48.8 years with extremes of 17 and 69 years. All our patients were male. 80% of our patients lived in adverse conditions. The average duration of the lesions was 8.1 years with extremes ranging from 6 months to 37 years. The average size of the loss of substance was 10.4 cm2 with extremes ranging from 04 to 18 cm2. The etiologies of the loss of substance were variable, dominated by loss of substance post-accident on a public road in more than 60% of the cases. 40% of our patients reported pain at the level of the site and 20% vertigo. Evolution of the lesions was regularly evaluated by clinical examination and photographs. Budding was obtained in 30% of the cases after grafting, epidermalization in 40% of the cases, and a very significant reduction in the size of the loss area in 30% of cases. The use of recombinant human factor is one of the encouraging therapeutic advances in regenerative medicine that has proven effective on chronic wounds with a reduced overall cost.

La main de presse: une brûlure pas comme les autres.

Burns to the upper limb caused by contact with a hot press are associated with a compression trauma of variable severity. These burns are rare, and they mostly occur in the context of accidents at work due to mishandling. They can cause severe multi-tissue injuries requiring urgent multidisciplinary care. Their psycho-social repercussions are considerable, especially as they affect a young population.

[Not Available]. / Brûlure chez l'épileptique: brûlure pas comme les autres.

The association of burns and epilepsy is frequent in Morocco. These burns, often recurring, mainly occur in young women living in rural areas. The accidents usually occur in the kitchen and involve falling onto stoves situated on the floor during an epileptic crisis. Such burns may occur during a first attack before epilepsy has been diagnosed although, more often than not, the patient's illness is already known but insufficiently treated and managed. Consequences of these burns, which are always deep, are often tragic considering the sequelae, in patients whose social reintegration is already marred by epilepsy. Treatment should focus on both burns and epilepsy. Preventive measures to keep the epilepsy in check and avoid these sufferers being left alone in proximity to heat sources should be put in place.

[Not Available]. / La greffe de peau totale dans le traitement des séquelles de brûlures de la main et des doigts: A propos de 84 cas.

We conducted a retrospective study of data from September 2004 to September 2012, involving roughly 84 patients with burn sequelae of the hand who were treated surgically with full thickness skin grafts. The purpose of our study was to show the simplicity, effectiveness and reliability of this surgical technique. The average age at which the burn occurred was 4 years old. The average age of our patients was 18,3 years old (range=2-62 years old); males were affected in 60% of cases. The most frequent cause of injury were thermal burns, most often caused by hot liquids (56%). The mean delay between the burn having healed and the management of the sequelae to the hand was 36 months (2 months-16 years). The lesions were localized in the palm of the hand in 69 cases (82,5%). The sequelae were dominated by finger contractures (65%). A functional deficit was noted in the physical examination of all our patients. Full thickness skin grafts were applied in all our patients following release of the contractures and excision of the scar tissue. Commissural contractures were treated with Z-plasties. In 95% of the cases, the full thickness skin grafts were taken from the inguinal crease. The mean follow-up was 5,5 years (1-8 years). Eleven patients went missing from the study. The results after healing and rehabilitation were deemed to be satisfactory (good) in 62 cases (85%) and fairly satisfactory (quite good) in 11 cases (15%). Well-conducted initial treatment, carried out under the best conditions, can not only reduce the number of burn sequelae but also make them less severe.

[Perineal-scrotal gangrene: epidemiological and therapeutic aspects. About 45 cases]. / La gangrène périnéoscrotale: profil épidémiologique et aspects thérapeutiques. À propos de 45 cas.

Perineoscrotal gangrene is an acute disease, a rare and severe affection of the perineum, whose evolution is unpredictable and rapidly extensive. The diagnosis is clinical. The paraclinical examinations allow early diagnosis and assessment of anatomical and biological repercussions. We conducted a retrospective study of 45 patients spread over six years, involving a multidisciplinary team consisting of three specialists (urologists, visceral, plastic surgeons). The average age was 52 years. The largely male dominated our series. Fournier gangrene was the most common etiology. We noted five cases of death (11%) in the acute phase, secondary to septic shock (four patients) or multiple organ failure (one patient). The evolution was favorable in 40 other patients in the series, requiring an initial management in intensive care unit, and surgical treatment. The average hospital stay was 17 days. After the acute phase, all patients underwent a surgery for skin coverage, ranging from guided healing (two patients) to musculocutaneous flap of the gracilis (six patients) via the secondary suture (four patients), the burying the testes (18 patients) and half thick skin graft, with a functional and aesthetic result was acceptable, and minimal sequelae. In our series, the most predictive prognostic factors would be the delay of care, sepsis on admission and associated diseases.

[Not Available]. / Ulcere de Marjolin: complication redoutable des sequelles de brûlures.

Marjolin's ulcer refers to the malignant, ulcerous transformation of burn scars or any other wounds. The predominant histological type is squamous cell carcinoma (SCC), and it is characterized by its aggressiveness and increased risk of recurrence and metastases compared to non-SCC scars. The work presented here is a retrospective study of 21 cases of Marjolin's ulcer, collected at the plastic surgery department of the CHU Mohammed VI in Marrakesh, with the aim of addressing the epidemiological, therapeutic and evolutionary aspects of this pathology. Improved prognosis requires not only early diagnosis and treatment, but also a preventive approach which consists of early skin grafts and regular care of any burn scar.

Epidemiology and treatment of paediatric burns in a large children's hospital in Morocco: analysis of 394 cases

Introduction:Injury from burns represents 2 of emergency admissions in university hospitals in Morocco. Burn injuries can lead to substantial morbidity in the paediatric population including an impact on later life. Methods:A retrospective study of 394 paediatric burn patients was performed. Subjects were identified by review of the emergency centre logs and data were extracted from patient records. Data included demographic information; mechanism of burn; treatment prior to arrival at the hospital; hospital management and follow up conditions : ResultsThe majority (65.7; n=259) of patients were between 1 and 4years old with an average age of 4.26years and male predominance (male:female=2:1). Scalding was the main mechanism of injury (83.5; N=329). The trunk and upper limbs were the most commonly affected areas of the body (59 and 50; respectively) with the face affected in 9.6 of cases. The total body surface area burned ranged from 1 to 10 in 86 of patients. Seventy-five patients (19) required hospitalisation; 57 patients (14) required skin grafting and 27 (6.9) had major sequelae. Discussion: This large case series highlights the current epidemiology; management and outcome of paediatric burn victims in Morocco. Current burn management in low resources settings can be challenging and several additional measures should be taken to reduce morbidity among paediatric burn victims

[Lipostructure® for morphologic restauration in Parry-Romberg syndrome: about 12 cases]. / Lipostructure® pour restauration morphologique dans le syndrome de Parry-Romberg : à propos de 12 cas cliniques.

INTRODUCTION: Progressive hemifacial atrophy, widely referred to as Parry-Romberg syndrome, is rare pathologic process characterized by idiopathic, self-limited, unilateral atrophy of different anatomic layers of the face. Restoration of contour and symmetry is the main challenge in cases of Parry-Romberg syndrome. Several means are tested but with a few satisfactions. Through this work, the authors report their personal experience with lipofilling in surgical treatment of this affection where sociopsychological impacts cannot be underestimated. MATERIAL AND METHODS: A retrospective study during one period being spread out over 4 years, undertaken on 12 patients presenting Parry-Romberg syndrome who profited from a lipofilling as described by S.R. Coleman "Lipostructure®". RESULTS: The average age of our patients was of 32 years old with a clear female prevalence. The right and left sides of the face was involved with equal frequency. The second territory of the trigeminal nerve was the most affected (75 % of cases). The moderate forms were found in 58,3 % of cases the results were collected after an average retreat 18 months. A subjective satisfaction was noted in 83 % of cases. Complications with type of pseudokystes and hypercorrection were observed in 16,4 % of cases. CONCLUSION: The lipofilling is a simple and reproducible process to established subcutaneous defect in hemifacial progressive atrophy. It constitutes for us a very good means in primary treatment of volumetric facial restoration in Parry-Romberg syndrome making it possible to obtain good results and to preserve some patients from hard surgery.

[Not Available]. / Chirurgie Plastique des Sequelles de Brulures de la Main. Experience du Centre National des Brules, Centre Hospitalier Universitaire de Casablanca.

Burns sequelae in the hand are frequent and various, ranging from the aesthetic and functional to the simple and complex. We report our experience of five years of burns sequelae treatment at the National Burns and Plastic Surgery Centre in the University Hospital Centre in Casablanca, Morocco. Our survey concerned 65 patients aged 2 to 70 years (45 men and 20 women) on whom we performed a total number of 143 surgical operations in 105 hands. The sequelae were located in the back of the hand in 57 cases, followed by the commissures in 43 cases. Various reconstruction methods were used, notably skin graft (58 cases) and local flaps (32 cases). We assessed the patients' level of satisfaction with the results achieved using the different methods and found that, with regard to skin graft, 94% were satisfied with the results achieved in the back of the hand, 90% with the local flaps in the first commissure, and 95% with distance flaps. With regard to reconstruction of the thumb, 100% of the patients treated with pollicization of a finger declared their satisfaction and 75% of those treated with transfer of the second toe.