[Extravasation injuries in newborns: our experience about 15 cases]. / Les accidents d'extravasation perfusionnelle chez le nouveau-né : une expérience de 15 cas.

Extravasation injuries are common complications that occur during infusion for diagnostic or therapeutic purposes by the peripheral or central venous catheters. In pediatric settings, iatrogenic extravasations are serious. When they are viewed late, they are sources of functional sequelae. The purpose of this study was to report our experience with the management of iatrogenic extravasations for therapeutic purposes. Between January 2010 and December 2012, fifteen newborns were supported for accidents of infusion of the upper and the lower limbs. The male was mostly affected. The mean age was 3.6days, with extremes of one and nine days. The average birth weight was 2900g. The range was 1200g and 3550g. Serum 10 % glucose and calcium chloride were implicated in all cases. The lesions were seen in the late stages III in six cases and IV in nine cases. The upper limbs were frequently affected. Nine lesions were in the upper limbs and six in the lower limbs. The dorsal surfaces, feet and hands were frequently affected in six and five cases, respectively. Two lesions were in the anterior aspect of the forearm and elbow. Elbows lesions were circular and realized a tourniquet effect. Treatment was conservative in eleven cases: five pro-inflammatory fatty dressings and six alcoholic dressings. The surgery was delayed in four cases. It combined excision-full thickness skin graft, excision-dressing-thin skin grafting, debridement and two-full thickness skin graft for retractable wrist scars. Two deaths were related to associate pathologies. One patient was lost for follow-up. Our results were satisfactory in functional, aesthetic and psychological aspects. Extravasation injuries are serious iatrogenic lesions. If the lesions are seen at an early stage in usual circumstances, in extreme exercise, they are seen late, sometimes at the stage of functional, psychological and cosmetic sequelae. The difficulty of the therapeutic management of these lesions requires prevention through the development of protocols and the permanent training of nursing staff for an efficient practice of infusion.

[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.

[Two cases of juvenile gigantomastia treated by reduction mammaplasty with nipple-areola complex graft]. / Gigantomastie juvénile: à propos de deux cas traités par la plastie mammaire de réduction avec greffe de la plaque aréolomamelonnaire.

Two cases of juvenile gigantomastia treated by reduction mammaplasty with nipple-areola complex graft. Juvenile gigantomastia or virginal hypertrophy is a volume anomaly of breast of the teenager. It is unsightly. But often, it is pain, impaired spinal posture and the shoulder girdle and the psychological effects that bring the teenager to make an application for aesthetic surgery. We report two cases of juvenile and bilateral gigantomastia in adolescents aged 13 years old and unresolved. They have lost their hope before surgical procedure. In both cases, treatment consisted of a reduction mammaplasty with nipple-areola complex graft according to the technique of Thorek. The total resection was 3500 and 2900 g of breast tissue in one and 4000 g per breast in the other. Satisfaction regarding the shape, size and symmetry of the reconstructed breast was good. Although the effects on breastfeeding remain patent, the psychological impact was favorable in all cases.

[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.