[Blast injuries of the hands in precarious health situation]. / Mains avec lésions de blast en situation sanitaire précaire.

UNLABELLED: The hands of "blast" resulting from the handling of unstable explosives. Their repercussion is functional and vital in trauma patients. The authors report their experience of care from the hands of blast in precarious health situation. PATIENTS AND METHODS: Between 2001 and 2012, 33 hand blasts were supported in 30 injured civilians and military, received emergency, during and after armed conflict. RESULTS: Two women (6.7%) and 28 men (93.3%) were received, including four teenagers (13.3%) and 26 adults (86.7%). During the war, 15 officers weapon (50%) and three civilians (10%) underwent surgery, or 60% of hand injuries. In peacetime, civilians were mostly operated in 33.3% of cases, against 6.7% of cases of agents' weapon. Nineteen hands blast (57.6%) were observed during the war and 14 in peacetime, or 42.4% of cases. The average age was 25.2 years, with extremes of 12 and 50 years. Thirteen left hands (39.4%) and 20 right hands (60.6%) were operated. The lesion concerned all the anatomical structures of the hand. It was unilateral in 27 cases (81.9%) and bilateral in three cases (9.1%). Three types of hand trauma were observed and were as follows: trauma patients with injuries of the hand (18.2%), trauma of severe and isolated proximal hand or finger amputations (75.7%), and trauma of the hand without apparent seriousness (6.1%). The associated lesion was eye (one case), chest (one case), abdominal (five cases). Debridement was performed immediate emergency (93.9%) and delayed (6.1%). The treatment was surgical hemostasis, made mainly of amputations (69.7%) and regularization of digital stumps (12.1%). The repair was performed in 18.2% of cases. One death has been reported in a polytrauma patient with chest blast. CONCLUSION: Blast injuries of the hand are common in times of war in armed agents. The young people, manual workers and children are paying a heavy price in peacetime. As land mines which affect feet, instable hand grenades are left exposed in nature. In precarious health situation, instead of a functional salvage surgery of the hand, it is a hemostasis surgery that makes many mutilated hand. The psycho-social aspect and vocational rehabilitation are additional difficulties supported.

[Giant rhinoscleroma]. / Rhinosclérome géant.

UNLABELLED: Rhinoscleroma is a chronic granulomatous respiratory tract disease. The initial lesion site is often intra-nasal. Giant tumor presentations are rare. The authors report a case of extensive nasal rhinoscleroma. OBSERVATION: A 35-year-old African male patient consulted for a large tumor of the nose. The tumor had appeared 25 years before; the initial lesion site was intra-nasal. It presented as a small non-obstructive growth. The tumor was removed 20 years before, and recurred in an exophytic presentation. The main tumor was associated to peripheral, peri-nasal, and upper lip nodules. There was a central granuloma, bleeding on contact. Nasal obstruction was complete. The histological and bacteriological examination of a biopsy specimen confirmed the diagnosis of rhinoscleroma. Trimethoprim-sulfamethoxazole was effective on the infection. DISCUSSION: Rhinoscleroma is frequently located on the nasal mucosa, but extra-nasal giant tumor presentations are rare. It can involve the whole respiratory tract. It is endemic in developing countries. Sporadic cases have been described in non-endemic areas, among migrants. The diagnosis is proved by histology. Specific and early antibiotic therapy is effective. It avoids surgical mutilation, sequels, and recurrence.

[Keloid scars on black skin: myth or reality]. / Cicatrices chéloïdes sur peau noire : mythe ou réalité

UNLABELLED: The keloid scar is a thick skin or the cornea of man, due to excessive accumulation of type I collagen in the dermis. Morbidity of the keloid is high, given the frequent recurrences and unpredictable. African blacks and Asians are most affected. The purpose of this study was to analyze the results of treatment of 149 cases of keloids and discuss the reality of keloids in the dark. PATIENTS AND METHODS: From 1990 to 2011, 98 patients were supported for 149 keloid tumors. RESULTS: Seventy-eight adults (79.6%) and 20 children (20.4%) were received. Sixty-four women (65.3%) and 34 men (34.7%) were supported, including 94 blacks (96%) and four redheads (4%). The average age was 25 years with extremes of 2 years and 54 years. The trauma was the dominant etiology in 63.1% of cases. The infection, burns and surgery were implicated in 16.8%, respectively, 15% and 4.7% of cases. The cephalic end, was the seat of choice for keloids, with 84 cases or 56.4%. The ear has been the preferred unit in 38 cases, or 25.5%. The body, legs and genital area were the site of keloids, respectively, in 22.8%, 17.5%) and 3.3% of cases. Keloidal field was found in 24.5% of our cases. The reasons for consultation were the disgrace aesthetics (56.4%), pain (65%), households suppurative intrakeloidal (44.9%), functional impairment (40.8%), and the psychological impact minor (15.3%) and no major suicide attempt (66.3%). Two surgical techniques were used: total excision (TE), with total skin graft immediate or deferred, or not expanded, and intrakeloid excision (IKE) with suture surgery was associated with intra-lesional steroids. Many complications have favored the occurrence of early or late recurrence in 100% of our cases. CONCLUSION: The keloid is not a homogenous biological entity. Its prevalence is higher among black and yellow, and lowest among whites. The research results are still being evaluated. The best prevention is to avoid the scar itself.

[Management of head and neck giant congenital nevi with skin expansion]. / Traitement des nævi géants congénitaux de l'extrémité céphalique par expansion cutanée.

INTRODUCTION: Giant congenital pigmented nevi are benign melanocytic tumors. The lesion transformation to a malignant melanoma is a rare but severe condition. Treatment is complex and often difficult. The purpose of this study was to analyze the results and discuss the contribution of expansion technique in the treatment of giant nevi of the cephalic extremity. MATERIAL AND METHODS: Six giant nevi (five children and one adult) were treated by skin expansion between 1993 and 2010. RESULTS: The nevus had a fronto-temporal region and vertex location (one case), and hemifacial in five cases. Subtotal resection of the nevus was performed in every case. The defect was filled by a double rotation flap of expanded scalp (one case), and an expanded total skin graft (five cases). Two complications were observed: a depression of the frontal bone in a 6-year-old child who had received a total prosthesis volume of 2000 mL; and migration of the valve under a prosthesis, which required repositioning. These complications did not alter the final results. DISCUSSION: The risk of evolution to a malignant melanoma is considerably decreased after exeresis of congenital nevi. Tissue expansion is a true skin bank. It allows treating giant congenital nevi of the scalp and face, with good esthetic results and less morbidity.

[Palmar and plantar keloid in a black African male]. / Chéloïdes palmaire et plantaire chez un Noir africain.

The keloid scar is a fibrous skin tumor, intradermal, and exuberant. It is commonly found on the glabrous skin. The keloid of the palms and soles are rare. Small series are reported in English literature. The authors report a case of large keloids located on both palms and soles, within a context of keloid disease, in a man of 37 years. On the left hand, the keloid scar caused a partial syndactyly IV-V. Large keloid tumors occupied the inner edge and, weight-bearing areas of both feet. These tumors rendered wearing of shoes impossible and interfered with walking. The treatment consisted of total excision of palmar and plantar keloid tumors. The residual defects were covered by a total skin graft taken from the suprapubic region. The results were satisfactory aesthetically, functionally and psychosocially.

[Destruction of a penile urethra resulting from a snake bite: Uretroplasty using inguinal flap of Mac Gregor]. / Destruction de l'urètre pénien consécutive à une morsure de serpent : urétroplastie par le lambeau inguinal de Mac Gregor.

Following a snake bite to the penis, a 69 years old man presented a large defect of hemicircumferential ventral penis, destroying the penile urethra along its entire length exposing the erectile bodies. The authors proposed a two-stage reconstruction of the urethra with an inguinal axial pedicle flap of Mac Gregor. This well-vascularized flap thick after degreasing helped repair the penile urethra along its entire length and make up losses of substance with a good functional and aesthetic result.

[Rhinophyma in a black African male patient]. / Rhinophyma chez un noir.

UNLABELLED: Rhinophyma is an irregular and progressive nasal hypertrophy, due to hyperplasia and fibrosis of the sebaceous glands and surrounding soft tissues. Its etiology is unknown. Its psychosocial, functional, and esthetic consequences may be severe. It is rare in the black African population. We present a case of glandular rhinophyma in a 70-year-old black male patient. OBSERVATION: A 70-year-old male patient consulted for nasal tumors. These lesions had appeared 11 years before, after rosacea acnea. The patient had no specific history, no alcohol addiction nor any particular treatment. The nose was voluminous. The tumors were located on the left nostril ala, the tip of the nose, and the tip and right nostril ala junction. The size of the pediculated lesions was variable. They covered most of the nostril opening and upper lip. Pressure forced out whitish, pasty, and fetid sebum. The lesions were an obstacle to nasal ventilation and feeding. This glandular rhinophyma was responsible for a severe social and affective handicap. It was treated by exeresis and simple closure, under local anesthesia. Operative follow-up was uneventful. No sign of relapse was noted at 20 months. The psychosocial, functional, and esthetic results were satisfactory. DISCUSSION: The rhinophyma is a rare presentation in the black African or Afro-American population. Three cases have been reported so far.

[Fibrolipoma of the median nerve. A case report]. / Fibrolipome du nerf médian : à propos d'une observation.

The authors report a case of fibrolipoma of the median nerve in a 6-year old boy presenting as macrodactyly with clinodactyly. The causal relationship between the nerve lesion and the deformities is discussed. The difficulties of diagnosis of the condition are presented as are the difficulties of management where a balance has to be struck between conservative treatment and amputation.

[Dupuytren's contracture. A report of three cases in Black Africans]. / La maladie de Dupuytren. A propos de trois cas chez le Noir Africain.

Having reported the first case of Dupuytren's disease in West Africa in 1990, the authors report two further cases, which brings the number of Dupuytren's disease reported in West Africa to three. The authors demonstrate by a literature review, that numerous cases had in fact been described in black people since 1974. The factors which are incriminated are always alcoholism, microtrauma and other factors like diabetes. Dupuytren's disease appears to be a condition, which is actually not so rare in black people after all.

Une nouvelle approche therapeutique dans le traitement des ulceres de buruli

l'ulcere de Buruli est une affection due au mycobacterium ulcerans qui entraine une importante destruction de la peau. Le traitement chirurgical consiste en de larges excisions suivies de greffes de peau mince. actuellement les pansements a l'acide acetique a 2 pour cent que les auteurs ont experimentes sur 17 malades permettraient d'eviter les excisions larges donc d'economiser de la peau pour ne se limiter qu'a la seule greffe cutanee lorsque l'ulcere ne cicatrise pas de lui-meme

[Darrier-Ferrand's dermatofibroma on the forehead. Wide cranial-cutaneous exeresis followed by scalp plastic surgery]. / Dermatofibrome de Darier et Ferrand du front. Exérèse large cranio-cutanée suivie de plastie du cuir chevelu.

The authors report on a case of Darier-Ferrand's dermatofibroma on forehead. It was a very uncommon localization. They stress on the specific treatment applied: forehead cranioectomy and scalp plasty, made compulsory after several exercises and their reappearances.

[Cure of an enormous eventration by abdominoplasty. Technical note. A case report]. / Cure d'une monstrueuse èventration par abdominoplastie. Note technique. A propos d'un cas.

The secondary eventrations after delivery are the prime cause of women's eventrations. These eventrations are enormous in Africa because the post-partum women do not make active movements to develop again the abdominal strap. In Europa or North America the treatment would make use of prosthetic materials but in Africa the climatic and working conditions do not take the utilization of such method. The authors purpose a cure allied aponevroplasty according to JUDD technique with abdominoplasty. The result is satisfactory and durable.

[Sequela of hand burns in children: 32 cases followed and treated in the Plastic Surgery and Reconstruction department of the University Hospital Center of Treichville, Abidjan]. / Les sequelles de brûlures de la main chez l'enfant: a propos de 32 cas suivis et traités à la Consultation de Chirurgie Plastique et Reconstructrice du Centre Hospitalier Universitaire de Treichville-Abidjan.

An investigation on the effects of hand burns has been undertaken about 32 children admitted in the plastic surgery outpatients Department. Accident occurs among the lower class population and heat is the major factor pointed out. The most frequent effects are hand palmar contracture. The surgical treatment completed with the functional re-education has given very good results in 79% cases. However the cheloid contractures are the most difficult to cure. Indeed the authors insist or the prevention and the creation of a center of burned patients and a plastic surgery Service to take care of patients whose life prognostic is optimistic.

[Treatment of Buruli's ulcers by excision-graft]. / Le traitement des ulcères de Buruli par excision-greffe.

Buruli's ulcer is a real disease of public health. In Ivory Coast, 50 patients were treated from February 1987 to August 1991. It realizes a real destruction of skin and subcutaneous tissues. The germ is Mycobacterium ulcerans. The preferential localisation is the limbs in children of 14 years old. Large ulcer with polycyclic margin are treated by extended excision and thin skin grafts. But deformities persist after the surgical treatment. Hospitalisation is long and drugs are expensive.

[Semilunar dislocations. A report of 8 cases. (Orthopedic service-University Hospital Center of Treichville-Abidjan)]. / Les luxations du semi-lunaire. A propos de 8 observations. (Service Orthopédie-Centre Hospitalier Universitaire de Treichville-Abidjan).

The authors have underlined in a study made on 8 observations that the lunate dislocation is scar. All their patients were men under 40 years old. Industrial injury was the most dominant cause. Using WITVOET and ALLIEU's classification, they noticed a predominance of perilunar and posterior dislocations (7/8 cases). Perilunar anterior dislocations and isolated scaphoid carpal dislocation have not been encountered. The treatment which has been orthopaedic or surgical has given moderate results: Good results = 4; Average result = 1; Bad results = 2; Non seen to again = 1 The authors think that a precocious diagnosis and an orthopaedic treatment in the forms detected early and surgical treatment in ancient forms are the only guarantee of a good functional result avoiding dread diseases such as carpal instability, radiocarpal arthrosis.

[Intra-keloid excision and deferred corticoid infiltration in the treatment of keloids. University Hospital Center of Treichville-Abidjan]. / Exérèse intra-chéloïdienne et infiltration différée de corticoïdes dans le traitement des chéloïdes. (Centre Hospitalier Universitaire de Treichville-Abidjan).

On a series of 38 keloid surgery patients the authors noted a strong female predominance and the frequency of ear lobule keloid. After some rather unsuccessful excision-suture of the keloid they recommend the intra- keloid excision to be followed by a late corticoid infiltration but deferred until the 15th day. The results obtained were encouraging but some researches have to be made with regard to the etiology of this affection which might probably resolve the therapeutic problem.

[Dupuytren's contracture: review of the literature. Case report of a black African]. / La maladie de Dupuytren: revue de la litterature. A propos d'un cas chez l'Africain noir.

In one case of Dupuytren's contracture the authors make an important literature review. The affection is rare with the black man but frequent in caucasian population. Its origin is therefore european. They point out alcoholism and microtrauma due to the patient's antecedents and job.

[Skin expansion in plastic surgery. (University Hospital Center of Treichville-Abidjan)]. / L'expansion cutanée en chirurgie plastique. (Centre Hospitalier Universitaire de Treichville-Abidjan).

The skin expansion by inflatable prosthesis is a recent method to resolve insufficient tissue a short series of 7 cases. But the authors think that despite these inconveniences this technique needs to be largely diffused and used judiciously.

[Microsurgery in revascularizations and replantations of the upper extremity in emergency cases. Department of Plastic and Reconstructive Surgery. University Hospital Center of Treichville-Abidjan]. / La microchirurgie dans les revascularisations et les réplantations du membre supérieur en urgence. Département de chirurgie plastique et reconstructrice Centre Hospitalier Universitaire de Treichville - Abidjan.

The authors report their experience in vascular and nervous microsurgery. They remark that there is a long time between the emergency reception of the wounded person and the appeal to plastic surgery. They deplore also the bad collaboration between the different department of emergency surgery. Finally they emphasize that the scarcity of cases is due to insufficient information of different departments of emergency surgery in microsurgery era.