[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

[Cephalic tetanus revealed by peripheral facial palsy]. / Tétanos céphalique révélé par une paralysie faciale.

INTRODUCTION: Cephalic tetanus is a rare presentation of localized tetanus (1 to 3% of localized presentations). It is a very rare cause of peripheral facial palsy. OBSERVATION: We report a case of cephalic tetanus revealed by peripheral facial palsy and trismus. DISCUSSION: Facial peripheral palsy often appears after trismus. It is very rarely the first symptom of cephalic tetanus, making the diagnosis difficult.

[Adenoid cystic carcinoma of the scalp]. / Carcinome adénoïde kystique du cuir chevelu.

BACKGROUND: Few cases of adenoid cystic carcinoma of the scalp have been described in the literature. Herein, we report a new case illustrating the difficulties of diagnosis and treatment of this rare form of tumour. CASE REPORT: A 49-year-old man consulted for a large ulcerated scalp tumour. The biopsy sample exhibited an aspect of cystic adenoid carcinoma. Bone invasion had occurred. Extremely wide surgical excision was carried out, extending down to the dura mater, with covering by means of a frontal flap with left temporal pedicle. Since the edges of the resection were also tumoural, postoperative radiotherapy at 56Gy was given. Twelve months later, the patient was still in remission. DISCUSSION: The standard treatment for adenoid cystic carcinoma is complete surgical excision but this approach may be complicated by difficulties relating to the degree of tumour spread or to the anatomical site. Postoperative radiotherapy appears to improve local control, as illustrated by our case.