Aesthetic Reconstruction Of Post-Burn Eyebrow Alopecia With A Superficial Temporal Island Scalp Flap: A Case Report And Review Of The Literature.

Eyebrows have a critical functional and aesthetic role on the face. Alopecia on the eyebrows has multiple origins, including scars formed after deep burns on the head and neck region. Reconstruction of the eyebrows represents a challenge for plastic surgeons due to their particular anatomical structure and variations inside of genders. Follicular Unit Transplantation (FUT) is believed to be the gold standard for the treatment of all sorts of alopecia, including that located on the eyebrows. However, FUT is technically demanding and requires skills, extensive anatomical knowledge, and equipment. In settings where FUT is still not feasible, flaps such as the superficial temporal artery island scalp flap remain reliable options. A 32-year-old male patient presented at the National Burn and Plastic Surgery Center, Casablanca (Morocco), with right eyebrow alopecia caused by fire burn on the face. We reconstructed the alopecia using a superficial temporal artery island scalp flap. The result was excellent. The patient and the physician were both very satisfied, and the patient stated that he was more comfortable with his social relationships. Among the current procedures used for the reconstruction of eyebrow alopecia, the superficial temporal artery island flap remains a versatile solution, especially after burn injuries in male patients.

Les sourcils ont des rôles fonctionnel et esthétique majeur au niveau du visage. Les alopécies sourcilières ont de multiples causes parmi lesquelles les brûlures. La reconstruction sourcilière doit tenir compte de leur structure anatomique particulière, qui plus est différente d'un sexe à l'autre. La transplantation d'unités folliculaires (TUF) est décrite comme le traitement de référence des alopécies, parmi lesquelles celles touchant les sourcils. Cette technique demande toutefois de l'entraînement, des connaissances anatomiques approfondies et du matériel spécifique. Quand la TUF n'est pas utilisable, le lambeau temporal superficiel en îlot (LTSI) est une alternative fiable. Un homme de 32 ans a été pris en charge dans le CTB national de Casablanca (Maroc) en raison d'une alopécie sourcilière droite consécutive à une brûlure, que nous avons traitée par LTSI avec un excellent résultat. Le patient comme le chirurgien étaient très satisfaits, le premier se déclarant beaucoup plus à l'aise dans sa vie sociale. Le LTSI est une solution polyvalente, ayant sa place dans la reconstruction sourcilière après brûlure, en particulier chez les hommes.

Auto-transplantation of amnion-chorion membrane in a burned pregnant patient at term.

Burn in pregnancy represents a threat to the mother and the fetus. Burn care in pregnant women is not well codified. An aggressive treatment including oxygen supplementation, smart fluid resuscitation and early excision has been reported. Nevertheless, auto-transplantation of amnion-chorion membrane in a pregnant woman with burns has not been reported to date. We present our first case of auto-transplantation of fresh amnion-chorion membrane in a pregnant woman admitted to our department with 14% TBSA deep and superficial burns associated with inhalation injury. The chorion-amnion membrane harvested after caesarean section was used to cover the excised and autograft sites. Outcome was good and all wounds healed. The child was healthy also.

La brûlure au cours de la grossesse représente une menace pour la mère et le foetus. La prise en charge de la brûlure chez la femme enceinte n'est pas encore bien codifiée. Un traitement agressif comprenant une oxygénation, une réanimation hydro électrolytique adéquate et une excision précoce a été rapporté. Cependant, l'autotransplantation de membrane chorio-amniotique prélevée chez la femme après accouchement n'a pas encore été rapportée. Nous présentons ici notre premier cas d'auto-transplantation de membrane chorio-amniotique fraîche chez une patient enceinte admise pour une brûlure de 14% de surface cutanée, profonde et superficielle associée à des lésions d'inhalation. La membrane chorio-amniotique prélevée après accouchement par césarienne a été utilisée pour couvrir les lésions superficielles et les lésions plus profondes excisées et greffées. Les suites ont été favorables. Les lésions ont cicatrisé et le nouveau-né se portait bien.

The pedicled groin flap in resurfacing hand burn scar release and other injuries: a five-case series report and review of the literature.

XX.

XX.

Traumatisme de la main par injection a haute pression.

Traumas to the hand due to high-pressure injection are relatively rare and therefore not well known to practitioners. Lesions, depending on the product injected and the injection site, can have serious aesthetic and functional sequelae. Treatment is based on surgery, antibiotic therapy and early and specific rehabilitation. We report our experience and a literature overview.

Epidemiology of nosocomial fungal infections in the National Center for Burns in Casablanca, Morocco.

Fungal infection is a leading cause of death in burns patients and incurs significant costs for burn units. Our aim was to determine epidemiology of these infections, and analyze risk factors in the burns intensive care unit of the National Center for Burns and Plastic Surgery at Ibn-Rochd University Hospital, Casablanca. It is a retrospective review of all patients admitted from 2011-2014 who developed cultures positive for fungal organisms. Criteria for nosocomial fungal infections were those of the Center for Disease Control in Atlanta (1988, revised 1992, 2004). Microbiological surveillance was carried out daily. Patient demographic data, % TBSA, type of infection, site(s), species and number of cultures, and risk factors for fungal infections were collected. Mean age of patients was 24.5 +/- 27.3 years; 63% were female. Mean % TBSA was 30.7 +/- 23.4%, and % FTSA was 21.7 +/- 20.1%. Injury due to flame was most common (82%), followed by scald (10%), contact (4%), electrical (3%) and chemical (1%). Incidence of nosocomial fungal infection was 10%. The fungal pathogen most frequently isolated was Candida albicans (65.7%), followed by other Candida species (18.6%). Aspergillus spp was present in 3.9% and was statistically associated with mortality (3.2%) and morbidity. In our study, risk factors for these infections were mostly degree of burn (mean TBSA = 30.7%) and prolonged broad-spectrum antibiotic therapy. These two factors were associated with a higher incidence of multiple positive cultures, and significantly increased mortality (21.6%). Amphotericin B and fluconazole were the most frequently used antifungal agents. Fungi are emerging as important nosocomial pathogens. The main clinical implications are thinking faster about fungi infections and being more careful with antibiotic prescriptions.

Les infections fongiques sont une cause majeure de mortalité chez les brûlés et en augmente significativement le coût de prise en charge. Cette étude a pour buts de déterminer l'épidémiologie et d'analyser les facteurs de risque de leur survenue dans le centre national des brûlés de l'hôpital Ibn-Roch de Casablanca. Il s'agit d'une revue rétrospective des patients hospitalisés entre 2011 et 2014 ayant eu des cultures fongiques positives. Les critères de définition d'une infection fongique nosocomiale (IFN) étaient ceux du CDC d'Atlanta de 1988, révisés en 1992 et 2004. La surveillance microbiologique était journalière. Les données démographiques, la surface atteinte, le type et le (les) sites de l'infection, l'espèce, le nombre de cultures positives on été colligés. Les facteurs de risque de survenue d'une IFN ont été analysés. L'âge était de 25,4 +/- 27,3 ans, 63% des patients étaient des femmes. La surface brûlée était de 30,7 +/- 23,4% dont 21,7 +/- 20,1% profond. Les brûlures par flammes étaient les plus fréquentes (82%), suivies des ébouillantements et des brûlures par contact. L'incidence des IFN était de 10%. Candida albicans y était l'espèce la plus largement représentée (65,7%), suivie par 18,6% de « Candida non albicans ¼. Aspergillus spp étaient retrouvés dans 3,9% des cas et clairement associés à la mortalité et la morbidité. Les facteurs de risque étaient essentiellement la surface brûlée et l'antibiothérapie à large spectre prolongée. Ils étaient associés à un plus grand nombre de cultures positives multiples et à une surmortalité (21,6%). L'amphotéricine B et le fluconazole étaient les antifongiques les plus prescrits. Les champignons devenant des agents fréquents d'infections nosocomiales, il est nécessaire d'y songer rapidement et de limiter les prescriptions d'antibiotiques.

Épidémiologie des brûlures de la main chez les enfants vus dans le Centre National des Brûlés et de Chirurgie Plastique de Casablanca, Maroc.

Hand burns in children are common and may lead to debilitating sequelae. Therefore, full functional restoration of the hand is the goal of treatment. To assess the epidemiological, clinical and development aspects of the burns, we conducted a retrospective study over 4 years, from January 2011 to January 2015. It evaluated 313 children suffering from burns and treated at the National Burn and Plastic Surgery Unit of Ibn Richd Teaching Hospital in Casablanca. Most patients were aged 3-6 years (70%), with a slight male predominance. Scalds accounted for 62% of the causes of burns, flames 33% and electricity 4.5%. Chemical and contact-related burns were anecdotal (1 case of each). Seventy-two per cent of the patients had partial thickness burns, which healed spontaneously. Awareness of and education on these accidents should be part of the school curriculum in order to reduce the incidence of burns in childhood.

[Epidemiological profile of children burns admitted at the National Center for Brules, Morocco]. / Profil epidemiologique des brulures d'enfants admis au Centre National des Brules, Maroc.

This retrospective study was performed in order to analyse the epidemiology and aetiology of 543 cases of paediatric burns and to determine the elements that might have contributed to their prevention, which remains the treatment of choice for this pathology. The paediatric hospitalization rate for burns was 45.7% (mean age, 4.25 yr), the highest proportion of patients (42.5%) being in the 1-5 yr age group. The male/female ratio in all age groups was 1.7/1. The environment where burn injury most commonly occurred was the home (85.1%), and with accidental causes, accounting for 96.5% of the causes (mainly liquids, 69.3%). The mean percentage of burned body surface area was 21% with a total burned body surface area of ≥ 20% in 52.3% of cases. The upper limbs (79.1%) were the most affected body site; and the children were referred from other hospitals in more than 6 h in 65.5% of cases. The mortality rate was 13.2%

[Post-burn cervical retractions: 45 cases and a survey of the literature]. / Les retractions cervicales post-brulure - a propos de 49 cas et revue de la litterature.

Post-burn cervical contractures are the consequence of deep burns, which are often neglected or badly managed. They affect the patients' general functioning, aesthetic appearance, and psychological state of mind, and treatment can be difficult. We conducted a retrospective study that lasted six years (January 2002-January 2008), analysing epidemiological and clinical features as well as the indications and therapeutic results of 49 patients presenting post-burn cervical contractures treated at the Moroccan National Burns Centre and in our surgery department. Children and young adults were the most affected, with a slight female predominance (59.2%). Domestic burns were the most frequent (93.9%) and thermal burns were the most prevalent aetiology of the accidents (98.0%). Facial burns sequelae were most frequently associated with cervical contractures (67.3% of cases), followed by trunk sequelae (46.9%). Moderate and severe cervical contractures (Achauer classification) were the most frequent, representing respectively 30.6% and 38.8% of the cases. Surgical treatment was based on skin graft (67.3% of cases), local plasties (24.5%), and flaps (8.2%). Among the 47 long-term patients studied, the functional and aesthetic results were considered good in 83.0% of cases and medium in 8.5%; repeat surgery was required in the remaining cases (8.5%). Epidemiologically (patients' age, sex, burn characteristics) and clinically (localization of sequelae, clinical forms), the results of our series are consistent with those in the literature. The importance of initial management (early excision-graft, pressotherapy, and immobilization by neck splint) in reducing the incidence and the severity of cervical burns sequelae is demonstrated. When surgical treatment is indicated, the choice of repair process essentially depends on the extent of the sequelae. Plasties (Z, IC, Y-V…) and local flaps, with or without expansion, are the classic indication in minor contractures. In severe and major contractures, opinion is divided on the choice between skin grafts and flaps. However, whatever surgical treatment is decided upon, rehabilitation is necessary for a final satisfactory result.

[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.

[Burns caused by paint thinner]. / Brulures par Diluant.

Flame deriving from paint thinner is not a rare cause of burns in Morocco and we thus considered it useful to conduct an epidemiological survey of paint thinner flame burns (PTFB) in the National Burns Centre (NBC) in the Ibn-Rochd University Hospital Centre in Casablanca, Morocco. The research covered the 10-month period from September 2007 to June 2008.The aim of our work was to present the characteristic features of such burns in order to prevent them by increasing public knowledge regarding the risks involved in using paint thinner, i.e. burns in particular. During the period in question, we colligated 17 cases of PTFB out of a total number of 356 patients admitted to the NBC for acute burns of all aetiologies. The patients' average was 32 yr and they were nearly all male (16 men/1 woman), with past histories of drug addiction and/or delinquency. They were all of low-level socioeconomic class and lived mainly in shanty towns. The burn was often secondary to street violence (92% of the cases).The mean burn surface area was 23% and the burns were often deep and located mainly in the upper limbs and the trunk.

[Not Available]. / Brulure par Foudre. A Propos d'une Observation.

Aussi loin que l'on remonte dans la littérature, on retrouve des récits relatant des accidents consécutifs à la fulguration chez l'homme. La foudre était alors associée à la colère des dieux ou à la notion de châtiment. La fulguration correspond à un transfert d'énergie entre un cumulonimbus de charge négative et un objet de charge positive se trouvant au niveau du sol. Les lésions déterminées sont à la fois thermiques et électrothermiques. Bien que l'arrêt cardiorespiratoire soit une cause bien documentée de décès, la plupart des cas rapportés dans la littérature décrivent un éventail très disparate des séquelles qui surviennent suite à cet accident. Les Auteurs rapportent le cas d'un patient atteint par la foudre en insistant particulièrement sur les complications neurologiques qui sont survenues en cours d'évolution. Se basant sur cette observation et sur une revue de la littérature, les Auteurs soulignent que le pronostic des patients atteints par la foudre est plus favorable que généralement rapporté.

[The use of preputial skin as cutaneous graft after circumcision. Report of 30 clinical cases]. / Utilisation de la peau préputiale comme greffon cutané après circoncision. A propos de 30 cas cliniques.

Through a study of 30 clinical cases, collected at the service center of plastic surgery and burns in Averroes University hospital at Casablanca, the authors underline the interest of using preputial skin as full-thickness skin graft for the treatment of burns and their sequelaes in non-circumcised boys, whose age ranged from one to four years. At this age, they are more exposed to domestic accidents. The preputial skin graft gives the advantage of the absence of scare prejudice at the donor site each time the circumcision is possible; and provides a skin of good elastic quality avoiding secondary retraction with a very favorable rate of graft intake. Although the application of this technique for other affections is possible, but remains limited by the hyperpigmentation of the graft.

Sequence determination and genetic analysis of the leader region of various equine arteritis virus isolates.

The entire leader sequence of ten equine arteritis virus (EAV) isolates including the Bucyrus reference strain was determined and analyzed at the primary nucleotide and secondary structure levels. The leader sequence of eight EAV isolates was determined to be 206 nucleotides (nt) in length, whereas those of the 86AB-A1 and 86NY-A1 isolates were found to be 205 and 207 nt in length, respectively. The sequence identity of the leader sequences between the different isolates and the Bucyrus reference strain ranged from 94.2 to 98.5%. An AUG start codon found at position 14 in all EAV isolates could initiate an open reading frame (ORF) that could produce a polypeptide of 37 amino acids, except for the 86NY-A1 isolate where the intraleader polypeptide would contain 54 amino acids. Five patterns of computer-predicted RNA secondary structures were identified in the ten EAV leader regions analyzed. All EAV isolates showed three conserved stem-loops (designated A, B and C). An additional conserved stem-loop (D) was observed in six EAV isolates, including the Bucyrus reference strain. Based on the presence or absence of stem-loop D, all EAV isolates analyzed in this study could be tentatively classified into two genogroups (I and II). The significance of the intraleader ORF and the predicted secondary structures has yet to be determined.

Nucleotide sequence and genetic analysis of the leader region of Canadian, American and European equine arteritis virus isolates.

The extreme 5' end, the entire leader sequence of the Arvac vaccine strain, and 10 equine arteritis virus (EAV) isolates, including the ATCC Bucyrus reference strain and 5 Canadian field isolates, were determined and compared at the primary nucleotide and secondary structure levels. The leader sequence of eight EAV isolates, including the Bucyrus reference strain, and the leader sequence of the Arvac vaccine strain was determined to be 206 nt in length (not including the putative 5' cap structure-associated nucleotide) whereas those of the 86AB-A1 and 86NY-A1 isolates were found to be 205 and 207 nt in length, respectively. The sequence identity of the leader sequences, between the different isolates and the Bucyrus reference strain, ranged from 94.2 to 98.5%. Phylogenetic analysis and estimation of genetic distances, based on the leader nucleic acid sequences, showed that all EAV isolates/strains are likely to represent a large phylogenetically-related group. An AUG start codon found at position 14 in all EAV isolates/strains could initiate an open reading frame (ORF) that could produce a polypeptide of 37 amino acids, except for the 86NY-A1 isolate where the intraleader polypeptide would contain 54 amino acids. Computer-predicted RNA secondary structures were identified in the 11 EAV leader regions analyzed. All EAV isolates/strains showed 3 conserved stem-loops (designated A, B and C). An additional conserved stem-loop (D) was observed in 7 EAV isolates, including the Bucyrus reference strain. The leader region distal to stem-loop D did not contain conserved sequences or stem-loop structures common to the EAV isolates/strains.

Cleavage efficiency by adenovirus protease is site-dependent.

The adenovirus protease cleaves consensus sequences (M/I/L)XGX-G and (M/I/L)XGG-X. Using purified recombinant protease, we showed that a peptide bearing the GX-G site was hydrolyzed more rapidly than a peptide bearing the GG-X site. The GX-G site was also preferentially cleaved on viral protein pVI which bears both sites of cleavage. Evidence is presented that suggests a biological role for this differential cleavage efficiency.

New stimulation ligand of the adenovirus 2 protease.

The catalytic activity of the adenovirus cysteine peptidase is increased by a specific 11-amino-acid peptide adduct (GVQSLKRRRCF, referred to as pVIc). To identify additional peptides which might bind and alter the activity of the protease, a cysteine-constrained random peptide phage library was screened. Of 29 different phages which were isolated, 7 contained the consensus sequence VEGGS. Despite a superficial similarity to the substrate cleavage site of the protease, the peptide was not digested by the enzyme. VEGGS and pVIc altered protease activity similarly without sharing sequence similarity. To similar degrees, pVIc and VEGGS (a) stimulated the activity of the recombinant protease, (b) had no effect on viral protease, (c) increased the fluorescence emission of tryptophan residues in the protease, suggesting a conformational change, and (d) inhibited wt virus infection, but rescued ts1 infection at the nonpermissive temperature. The experiments also suggest that once the protease has been stimulated by one peptide, the other peptide has no further activity on the recombinant adenovirus cysteine protease, suggesting that the two peptides bring about the same change on the protease via different binding sites.

Mutagenesis of conserved residues of the adenovirus protease.

Based on the alignment of 12 adenovirus protease sequences, we have identified eleven conserved residues for mutagenesis. Eight of these, E5, D26, N44, E71, D77, D102, N144, and N170, are potential candidates for the third residue of the active site triad. N44, E71, N144, and N170 proved to be essential for enzyme activity. Glutamic acid 71 was proposed for the active site. Mutation of the three conserved cysteines suggested that C122 is the active nucleophile, C104 is the target for activation by peptide pVIc, and C126 is dispensable. Rescue of enzyme activity of the C104 G mutant by pVIc suggested that disulfide bond formation between the peptide and the protease may not be absolutely essential for stimulation of enzyme activity.

Adenovirus type 2 endoprotease: isoforms and redox effects.

The cysteine protease encoded by adenovirus type 2 contains eight cysteines, some of which are involved in catalysis and enzyme activation. Here we investigated the effects of oxidation, mercapto-ethanol, dithiothreitol, diamide and protein disulphide isomerase on wild-type and mutant enzymes. Three isoforms of the enzyme were detected in infected cells and a fourth in preparations of purified recombinant enzyme. The latter isoform was absent in preparations of enzyme mutated at any of the three conserved cysteines, C-104, C-122 and C-126. Enzyme activity could be stimulated by agents other than the authentic activating peptide (pVIc), such as cysteamine, though less efficiently. Diamide at low concentrations stimulated the activity of the ts1 enzyme, but inhibited both ts1 and wild-type enzyme at higher concentrations. Protein disulphide isomerase failed to restore enzyme activity to the oxidized isoform. The present studies in combination with previous results using mutants appeared to rule out amino acids C-67, C-122, C-126 and C-127, leaving the two remaining semi-conserved C-17 and C-40 and the conserved C-104 as potential candidates for binding peptide pVIc.

[Linitis plastica of the digestive tract. A case with involvement of the stomach and rectum]. / La linite plastique digestive. A propos d'un cas de localisation gastrique et rectale.

The digestive linitis plastica is a special form of the little differentiate adenocarcinoma that can reach all the segments of the digestive tube, if the gastric localization is the most frequent, the double gastric and rectal localization is rare (7%) either is simultaneous or successive. The pathologic examination arrives only at the diagnostic of the digestive linitis without biasing against its primitive and secondary character. We report a case of this association in order to focus the importance of search and difficulty of the histologic diagnosis. Mis H.N., aged of 69 years old was hospitalized because she was reached of subocclusive syndrome, the rectal touch, found a circumferential marrowing with indurated basis at 7 cm of the anal margin, the gastroduodenal transit and the high digestive fibroscopy were evokating of a total plastic linitis. The gastric biopsy confirmed the diagnosis by the presence of cells ou kitten ring. The patients died during the hospitalization, the pathologic study of the postmortem rectal swab showed the existence of a rectal linitis. The discovery of a gastric linitis makes necessary a systematic, endoscopic and radiologic complete physical examination in order to discover other digestive localizations, this darkens singularly the prognosis and complicates the therapeutic attitude.

Electrophoretic and spectral characterization of wild type and mutant adenovirus protease.

The P137L mutation in the adenovirus type 2 protease results in a temperature-sensitive protein-trafficking phenotype expressed during infection but not in vitro. Homology-derived secondary structure prediction placed the mutation within an externally disposed loop. Circular dichroism and urea gradient gel electrophoresis suggested that, unlike other thiol proteases, the Ad2 protease is comprised of a single conformational domain. The -0.32-kcal difference in the free energy of folding and the temperature-independent CD spectra of the mutant and wild type enzymes point to a very subtle structural change as the cause of the in vivo phenotype.