Use of an artificial dermis (Integra) for the reconstruction of extensive burn scars in children. About 22 grafts.

We used an artificial dermis (Integra) for the reconstruction of extensive burn scars in children. Integra was initially developed for the primary coverage of acute burns, but several authors report good experiences with Integra for reconstructive surgery. We present a group of 10 children who underwent Integra grafting at 22 different operational sites. Five children received several grafts with Integra. On average, 260 cm(2) per session were grafted. We compared the surface of Integra on the day of grafting and then again on the evaluation day to measure the secondary retraction of the grafts. Complications (infection of Integra, failure of the epidermal graft) were observed in 5 cases. At the final evaluation, 20 grafts were visible. The surface of the Integra graft represented less than 50% of the initial surface in 7 cases, 51-75% in 5 cases and more than 76% in 8 cases. The disadvantages of Integra in reconstructive surgery are that two operative procedures are necessary and the recurrence of contraction seems to be more significant than with full thickness auto grafts. However, Integra has many advantages: the immediate availability of large quantities, the simplicity and reliability of the technique, the pliability and the cosmetic aspect of the resulting coverage. In light of these preliminary results, Integra appears to offer a new alternative for the reconstruction of extensive burn scars in children.

[Buruli disease and plastic surgery]. / Ulcère de Buruli et chirurgie plastique, au dispensaire.

The Buruli ulcer is a skin infection with Mycobacterium ulcerans which progresses silently. This infection affects mostly women and children who live near stagnant waters. Buruli ulcer is disease that has terrible consequences if not promptly diagnosed and treated. It destroys progressively skin tissues and consequently leaves very important scars. There is no efficient medical treatment. This presentation proposes to take care efficiently of the Buruli ulcer by simple plastic surgery techniques. We relate our experience of a mission in Benin, in the context of the national programme of struggle against the Buruli ulcer.

[Burn sequelae in developing countries]. / Les séquelles de brûlure dans les pays en voie de développement.

Based on their experience in the reconstruction of burn sequelae acquired over the last decade in India and Africa, the authors try to define a number of elements applicable to every case and in every country: the importance of preparation of missions in the foreign country and in France, concerning material and all team personnel; the particular conditions of anaesthesia-intensive care; surgical criteria of efficacy, rapidity, simplicity and reproducibility. Full-thickness skin grafts and reliable local or regional flaps are the preferred techniques. The authors consider that there is no place for expansion prostheses and microsurgical free flaps in this setting.

[The saphenous flap called the Acland's flap. Report of 2 cases]. / Le lambeau saphène dit lambeau d'Acland. A propos de deux cas.

The authors present two cases of Acland's flap. This flap described and published in 1981, is a very good flap, but the myocutaneous flaps have limited its use. However, the authors believe that there are indications for this saphenous flap. The vascular supply for this flap is a saphenous artery, the last branch of the femoral artery, before it becomes the popliteal artery. The authors report two cases: one neurovascular island flap for the posterior side of the knee, and the other case is a free flap for forearm. This flap is part of a particularly rich arterial network on the medial side of the thigh and of the knee. Masquelet, in 1986, showed that it is possible to raise a periosteal flap or a vascularized tendon flap.