RESUMO
Pediatric burn injuries are frequently complicated by burn scar contractures that often create functional limitations. Usually release followed by skin grafts, local flaps or tissue expansion is adequate. In rare instances, when the contracture is severe and simpler forms of reconstruction have failed, microsurgical free tissue transfer becomes essential. Even though in pediatric patients it can be technically more demanding and there is a reported risk of vasospasm, free tissue transfer has proven to be a good alternative. It is a one-stage procedure that guarantees decent functional outcomes. The perforator anterolateral thigh flap is a workhorse flap in microsurgery. The versatility of this flap allows it to be used in various anatomic locations. In this paper we report its use in neck, wrist, foot and face reconstructions. Flap success rates were 100%, with no cases of partial or complete flap loss. No acute or chronic complications were noted. Only one patient required reoperation for thinning of the flap to allow proper shoe fitting. All patients had good functional outcomes and the contractures were fully released. Joint function was regained in all patients except one that required wrist fusion. When indicated, the free perforator ALT flap is an excellent option for challenging reconstructions.
Les brûlures de l'enfant se compliquent souvent de rétractions cicatricielles entraînant des limitations fonctionnelles. Le plus souvent, la libération suivie de greffes, de lambeaux locaux, de lambeaux expansés est une solution efficace. Dans de rares cas, lorsque la rétraction est importante et que les techniques simples ont échoué, l'utilisation de transferts tissulaires micro-anastomosés devient nécessaire. Même si chez l'enfant la technique peut être plus difficile et que l'on rapporte des risques de spasmes vasculaires, les transferts tissulaires micro-anastomosés se sont montrés être une alternative utile. Il s'agit d'une procédure en un temps qui assure un résultat fonctionnel satisfaisant. Le lambeau perforant antérolatéral de cuisse est le lambeau favori en microchirurgie. La polyvalence de ce lambeau permet son utilisation dans des localisations anatomiques très diverses. Dans cet article, nous rapportons son utilisation au niveau du cou, du poignet, du pied et de la face. Le taux de réussite du lambeau était de 100 %, sans aucun cas de perte partielle ou complète du lambeau. Aucune complication immédiate ou secondaire n'a été notée. Un seul patient a nécessité une reprise du lambeau pour l'affiner, afin de permettre un chaussage correct. Tous les patients ont eu un bon résultat fonctionnel et les rétractions ont été complètement libérées. La mobilité articulaire a été récupérée pour tous les patients sauf pour un qui a nécessité une arthrodèse au niveau du poignet. Le lambeau perforant antérolatéral de cuisse libre est une excellente solution pour les reconstructions difficiles.
RESUMO
INTRODUCTION: Corneal ulcers in contact lens wearers are becoming more common, and can sometimes lead to severe complications. The purpose of this study is to define the epidemiological, clinical, microbiological and therapeutic considerations of these ulcers within the above context. PATIENTS AND METHODS: We conducted an uncontrolled, descriptive, retrospective study of 51 patients presenting with contact lens related corneal ulcers to the ophthalmology department of the August 20, 1953 Hospital in Casablanca between January 2009 and January 2012. RESULTS: The average age of our patients was 22 years, with a gender ratio of 7.5 female to male. General risk factors (diabetes and tuberculosis) were found in 17.5% of cases. The average length of hospital stay was 15 days. Of our patients, 58.8% wore cosmetic contact lenses and 41.18% wore therapeutic contact lenses. Mean duration prior to consultation was 5 days. The predominant clinical signs were eye pain and redness, with a decrease in visual acuity worse than 1/10 in 82.3% of patients. In 70.6% of cases, the ulcer was central. The average size was 4.3mm. An anterior chamber reaction was found in 47.1%. Corneal bacterial cultures were positive in 47.8%. Pathogens found were Staphylococcus aureus, Pseudomonas aeruginosa and AcanthamÅba. Contact lens and solution cultures were positive in 73.6% of cases. Outcomes were favorable with local and systemic antibiotic treatment adapted to microbiological results in only 41.2% of cases. In the remaining patients, significant secondary opacities persisted. DISCUSSION: Cosmetic and therapeutic contact lens wear is a major cause of corneal ulcer. Delayed consultation results in severe sequelae with persistently decreased visual acuity. CONCLUSION: The ophthalmologist plays an important role in preventing complications of contact lens wear, through better hygiene instruction and follow-up of his or her patients.
