[Reconstruction of orbital exenteration defects: about 20 cases]. / Couverture des cavités d´exentération: à propos de 20 cas.

The face is social support. Eyes allow the individual to interact with the environment and others. Orbital exenteration defects are the results of extreme disfiguring surgery, leading to functional, aesthetic and psychological sequelae. Reconstruction is essential and must meet several objectives: filling the cavity and closing any communications with the adjacent structures, obtaining rapid healing, allowing for local monitoring and finally enabling patients to reintegrate into society and achieve a satisfactory quality of life. We here present our experience in filling and reconstructing these cavities. Our study involved 20 patients with orbital exenteration defects over a period of 5 years (February 2015-February 2020). We analyzed the epidemiological features, clinical profile, and methods of the reconstruction as well as patients´ outcomes in our hospital. The average age of patients was 58.5 years. Squamous cell carcinoma was the main histological type, followed by basal cell carcinoma. Filling techniques included directed wound healing (7 cases), temporalis fascia flap (2 cases), temporalis muscle flap (10 cases). Methods of reconstruction included directed wound healing (6 cases), full-thickness skin graft (1 case), mediofrontal flap (6 cases; alone or associated with the temporalis muscle), converse scalping flap in three cases. Free latissimus dorsi flap was used in two cases. Thirteen patients showed good outcomes, with good healing after an average follow-up period of 9 months. The most common complication was infection and suture release. Two patients were lost to follow-up. Orbital exenteration defects can be approached in many ways. Temporalis muscle flap has been shown to be a robust and safe choice as well as an excellent filling solution. Prostheses are an aesthetic but expensive solution that should be developed in our hospital.

[Surgical treatment of scrotal lymphedema]. / Traitement chirurgical d'un lymphœdème scrotal.

Scrotal elephantiasis is defined as an increase in the scrotal volume which can reach a very large size. This study involved O.H, a married man aged 70 years, father of 4 children, farmer, native of and resident in Agadir (south of Morocco). Symptoms started 7 years before when scrotal edema and then an edema in both feet and legs gradually increasing in volume occurred. Physical examination showed scrotal elephantiasis with a circumference measured 80 cm and elephantiasis in both legs and feet. Locoregional assessment was based on pelvic magnetic resonance imaging (MRI). The patient was scheduled for monoblock scrotal resection under spinal anesthesia with removal of all of the tissue affected by the lymphedema around the testicle which were covered using the remaining skin and of the penis which was skin grafted using thin skin. The treatment aimed to ensure penis function and to manage the disfiguration. Conservative treatment based on lymphovenous bypass surgery or on the dilation of lymph vessels is no longer performed. Treatment is based on surgery. Surgery is avoided when there are absolute contraindications.

[Vitiligo and Koebner phenomenon following platelet-rich plasma injections]. / Vitiligo et phénomène de Koebner suite à des injections de plasma riche en plaquettes.

Vitiligo is a common and acquired skin pigmentation disorder characterized by a selective and often continuous loss of epidermal melanocytes. We report the case of a female patient who developed facial vitiligo following platelet-rich plasma injections. The diagnosis of Koebner phenomenon was retained in order to explain the occurrence of vitiligo on the areas where platelet-rich plasma (PRP) had been injected.

The bacteriological profile of the burned patients in the center of burns in CHU Mohamed VI Marrakech (about 123 cases).

The bacterial nosocomial infection is one of the leading causes of morbidity and mortality for burned patient; we conducted a retrospective study of 123 patients hospitalized in the burns center CHUMED VI of Marrakechover a period of 3 years, from January 1st, 2013 to December 31st, 2016. The criteria for nosocomial infection were those of the Center for Disease Control in Atlanta in 1988. Incidence rates were calculated. The bacterial ecology of the department was described as also antibiotype. The predominancy of the population was male. The cumulative incidence was 103 infections per 1000 days of treatment. Regarding the characteristics of bacterial infections, infected sites were skin (69%), blood (18%), urinary tract (12%) and lungs (1%). The main organisms were: Staphylococcus sp. (37.7%), Pseudomonas aeruginosa (19.8%), Enterococcus faecalis and Proteus mirabilis (18.5%). Staphylococci were resistant méticillo-in 22% of cases. Pseudomonas and Acinetobacter were multi-resistant (66%). The establishment of the bacterial ecology of the service, helped us set the right rules of prescription of antibiotics, which was based on the infected site, the type of organism, its sensitivity, the molecule used and the pharmacokinetics particular patient burned. The two main organisms being Staphylococcus and Pseudomonas aeruginosa, antibiotics used in the Service will then beta-lactams, glycopeptides, fluoroquinolones and aminoglycosides. Finally, to control the epidemic risk posed by the emergence of resistant organisms is necessary to combine the practice of good antibiotic therapy and prevention.