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.

[LLL plasty: simple procedure for coverage of cutaneous defects]. / La plastie en LLL: méthode simple pour la couverture des pertes de substance cutanées.

Skin defects may be due to several causes: trauma, surgical excision of malignant or benign, even malformative pathologies. The aim of this work is to report the interest of the LLL flap (L for Lozenge) (Dufourmental flap) in the coverage of the skin defects that sometimes may reach high dimensions or being located in areas of lower skin extensibility. We report a study involving 26 patients who all benefited from this technique having skin defects due to different causes and serving in different locations. LLL plasty allowed a first closure in all patients. The cosmetic result was good and no recovery was necessary. LL plasty was first described in 1962 to cover limited skin defects. However, it requires some precision in its execution. This is a simple and reproducible procedure with considerable interest for its potential in the coverage of cutaneous defects in the face and that can reach up than 8cm. The scar would be reduced if we took care to match the areas of sutures with the shaded areas of the face (groove…). While allowing a better distribution of tension, this technique has demonstrated its superiority compared to direct suture, which the indication is limited by the size of the defect and its location (peri-orificial…) and other techniques that are similar as the Limberg flap.

[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.

[Epidemiology of burns in Marrakech: 152 cases considered]. / Profil épidémiologique des brûlés à Marrakech: à propos de 152 cas.

This paper is a retrospective epidemiological study of 152 burn patients hospitalized between 2006 and 2008. The patients were aged less than 20 years in 65% of cases. The sex ratio (m/f) was 1.18/1. A thermal origin was responsible in 84% of the cases. Flame was the cause in 56% of cases. The average burned body surface area was 28% and second-degree burns were the most frequent. In our study, the face and the neck were the body area most frequently involved. Prevention continues to be the best weapon to combat this problem, for which objective several measures are proposed.

[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.

[Not Available]. / Aspect Epidemiologique des Sequelles de Brulures a Marrakech, Maroc, a Travers Deux Observations.

La brûlure est un accident qui reste toujours très fréquent au Maroc, ce qui fait d'elle un problème de la santé publique. Les brûlures, quand elles sont graves ou profondes, entraînent de façon quasi inéluctable des séquelles fonctionnelles et esthétiques. A travers deux observations de deux enfants présentant des séquelles de brûlures graves, ayant retenti péjorativement sur leurs scolarités, on a essayé de mettre en évidence quelques facteurs incriminés dans cette tragédie (feu, petites bouteilles de gaz et le manque d'infrastructure, du personnel médical et paramédical, du matériel ainsi que de la prévention) comme étant une grande cause dans la survenue de ces séquelles. Le but de notre travail est d'énumérer ces différents facteurs intriqués, ainsi que de proposer quelques solutions, tout en insistant sur la prévention.

[Not Available]. / L'Apport de la Greffe de Peau Totale dans le Traitement des Sequelles des Brulures de la Main: a Propos de 14 Cas.

La main est fréquemment exposée aux brûlures, ce qui entraîne des séquelles cutanées. A partir d'une série de 14 patients suivis dans notre service sur une année, nous avons essayé d'établir la simplicité, l'efficacité et le rôle de la greffe de peau totale dans le traitement de ces séquelles (les organes nobles ne sont pas mis à nu). La greffe de peau totale associée à une rééducation efficace permet aux patients de reprendre la mobilité des mains dans les brefs délais.

[Thoracic reconstruction by a free fibulaire flap and latismus dorsi]. / Reconstruction de la paroi thoracique antérieure par lambeau fibulaire libre et latissimus dorsi.

In order to preserve the respiratory function of the thorax the reconstruction must be immediate and must answer currently to principles of repair very codified. We reported a case of thoracic reconstruction by an association of flaps, free fibular and pedicled of the latismus dorsi, after a resection of a shrewd tumour of the thoracic partition. This reconstruction has permitted the contribution of a musculocutaneous cover of good quality and the contribution of a skeletal support satisfying at a time. The association of flaps can be considered like one of the solutions for the reconstruction of the big losses of substance of full thickness of the thoracic partition requiring a restoration of the thoracic skeleton.

[Not Available]. / Variete Technique du Lambeau Sural dans les Brulures Profondes du Pied.

Les couvertures des pertes de substance de la jambe, du talon et du pied font souvent appel au lambeau sural, qui reste, de part ses dimensions, une indication limitée. Les Auteurs présentent, à travers deux cas cliniques, une variété technique pour la levée du lambeau sural, permettant d'obtenir des palettes cutanées de grande surface avec une bonne sécurité vasculaire. C'est un lambeau fasciocutané remontant jusqu'à un centimètre du creux poplité et incluant, lors de la levée, l'aponévrose, le nerf sural, la petite veine saphène et le nerf sural latéral.