[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.

[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.

Aetiology of burn injuries in childhood in Casablanca, Morocco: epidemiological data and preventive aspects.

A retrospective epidemiological study is reported concerning burn injuries in 775 children hospitalized at the unit of burn care of Casablanca between 1985 and 1993. The mean age was 3 years and 8 months; 69.9 per cent of the patients were below 5 years old. The male to female ratio was 1.43 to 1.0. The most common agents were scalding liquids (69.1 per cent) followed by flames (15.2 per cent). The authors underline through this report that preventive measures depend closely on the regional, environmental and sociocultural specificity.

[Cutaneous tumors during xeroderma pigmentosum in Morocco: study of 120 patients]. / Tumeurs cutanées au cours du xeroderma pigmentosum au Maroc.

INTRODUCTION: Xeroderma pigmentosum is a rare recessive and autosomically transmitted genodermatosis. Its cutaneous manifestations are dominated by skin cancers. This investigation aims at studying the epidemiologic, clinic, histologic, therapeutic and evolutive aspects of the skin tumors during xeroderma pigmentosum. PATIENTS AND METHODS: A retrospective monocentric study was carried out in the Dermatology and Veneorology Department of Ibn Rochd University Hospital of Casablanca, Morocco. It included all the xeroderma pigmentosum admitted to hospital or followed-up from 1990 to 2000. All the dossiers were included. The anatomopathologic study was carried out in all the skin tumor cases. RESULTS: One hundred and twenty xeroderma pigmentosum were admitted in 10 Years. Fifty-four percent of the cases were females and 46 p. 100 were males. The mean apparition of the first tumor was 7.7 Years. One hundred and fifty-three skin tumors were diagnosed in 96 patients (80 p. 100). These tumors were of basocellular carcinoma type in 32.6 p. 100, of squamous cell carcinoma type in 33.9 p. 100 and of melanoma type in 11 p. 100. Ocular tumors were found in 31 cases (25.8 p. 100) and buccal in 8 cases. Therapeutically, the surgical exeresis of one or many tumors was performed in all cases. Electrocoagulation was associated in 42 p. 100 of the cases and skin graft in 52 p. 100. Cutaneous relapses after surgery were noticed in 55 cases (57.2 p. 100). Twenty-five patients died and 31 were lost to follow-up. DISCUSSION: Our series is characterized by a large frequency of mainly cutaneous tumors (80 p. 100) in comparison with the largest review of literature (45 p. 100). These tumors were mainly represented by basocellular and squamous cell carcinoma with onset at an early age (7.7 Years). Our series is also characterized by a large frequency of cutaneous relapses after surgery (51.6 p. 100). Neglecting advice on photoprotection and the lack of regular control visits lead to the proliferation of large size tumors, making therapeutic strategies difficult or even impossible.

[Post-burn cervical retractions: 45 cases and a survey of the literature]. / Les retractions cervicales post-brulure - a propos de 49 cas et revue de la litterature.

Post-burn cervical contractures are the consequence of deep burns, which are often neglected or badly managed. They affect the patients' general functioning, aesthetic appearance, and psychological state of mind, and treatment can be difficult. We conducted a retrospective study that lasted six years (January 2002-January 2008), analysing epidemiological and clinical features as well as the indications and therapeutic results of 49 patients presenting post-burn cervical contractures treated at the Moroccan National Burns Centre and in our surgery department. Children and young adults were the most affected, with a slight female predominance (59.2%). Domestic burns were the most frequent (93.9%) and thermal burns were the most prevalent aetiology of the accidents (98.0%). Facial burns sequelae were most frequently associated with cervical contractures (67.3% of cases), followed by trunk sequelae (46.9%). Moderate and severe cervical contractures (Achauer classification) were the most frequent, representing respectively 30.6% and 38.8% of the cases. Surgical treatment was based on skin graft (67.3% of cases), local plasties (24.5%), and flaps (8.2%). Among the 47 long-term patients studied, the functional and aesthetic results were considered good in 83.0% of cases and medium in 8.5%; repeat surgery was required in the remaining cases (8.5%). Epidemiologically (patients' age, sex, burn characteristics) and clinically (localization of sequelae, clinical forms), the results of our series are consistent with those in the literature. The importance of initial management (early excision-graft, pressotherapy, and immobilization by neck splint) in reducing the incidence and the severity of cervical burns sequelae is demonstrated. When surgical treatment is indicated, the choice of repair process essentially depends on the extent of the sequelae. Plasties (Z, IC, Y-V…) and local flaps, with or without expansion, are the classic indication in minor contractures. In severe and major contractures, opinion is divided on the choice between skin grafts and flaps. However, whatever surgical treatment is decided upon, rehabilitation is necessary for a final satisfactory result.

[Epidemiological profile of children burns admitted at the National Center for Brules, Morocco]. / Profil epidemiologique des brulures d'enfants admis au Centre National des Brules, Maroc.

This retrospective study was performed in order to analyse the epidemiology and aetiology of 543 cases of paediatric burns and to determine the elements that might have contributed to their prevention, which remains the treatment of choice for this pathology. The paediatric hospitalization rate for burns was 45.7% (mean age, 4.25 yr), the highest proportion of patients (42.5%) being in the 1-5 yr age group. The male/female ratio in all age groups was 1.7/1. The environment where burn injury most commonly occurred was the home (85.1%), and with accidental causes, accounting for 96.5% of the causes (mainly liquids, 69.3%). The mean percentage of burned body surface area was 21% with a total burned body surface area of ≥ 20% in 52.3% of cases. The upper limbs (79.1%) were the most affected body site; and the children were referred from other hospitals in more than 6 h in 65.5% of cases. The mortality rate was 13.2%

[Burn patients and their respiration problems]. / Les troubles respiratoires chez le brule.

The characteristic features of respiratory disorders in burn patients are presented in a review of the literature. Respiratory disorders in burn patients are related to a direct mechanism, when the bronchial tree is injured by the transfer of thermal energy due to the burn, and/or by an indirect mechanism, when the lung's respiratory and ventilatory function is impaired by localized, regional, or general burns-related phenomena. These respiratory disorders are aggravated by the inhalation of gases contained in smoke. Diagnosis of these disorders is clinical and paraclinical, and has to be performed early and continuously. The patients require various types of therapy, e.g. oxygen therapy, clearing of the airways, improvement of ventilatory mechanics and respiratory function, antibiotic therapy, or surgical correction of sequelae. This taking in charge inevitably has to be multidisciplinary.

[Burns caused by paint thinner]. / Brulures par Diluant.

Flame deriving from paint thinner is not a rare cause of burns in Morocco and we thus considered it useful to conduct an epidemiological survey of paint thinner flame burns (PTFB) in the National Burns Centre (NBC) in the Ibn-Rochd University Hospital Centre in Casablanca, Morocco. The research covered the 10-month period from September 2007 to June 2008.The aim of our work was to present the characteristic features of such burns in order to prevent them by increasing public knowledge regarding the risks involved in using paint thinner, i.e. burns in particular. During the period in question, we colligated 17 cases of PTFB out of a total number of 356 patients admitted to the NBC for acute burns of all aetiologies. The patients' average was 32 yr and they were nearly all male (16 men/1 woman), with past histories of drug addiction and/or delinquency. They were all of low-level socioeconomic class and lived mainly in shanty towns. The burn was often secondary to street violence (92% of the cases).The mean burn surface area was 23% and the burns were often deep and located mainly in the upper limbs and the trunk.

[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]. / Chirurgie Plastique des Sequelles de Brulures de la Main. Experience du Centre National des Brules, Centre Hospitalier Universitaire de Casablanca.

Burns sequelae in the hand are frequent and various, ranging from the aesthetic and functional to the simple and complex. We report our experience of five years of burns sequelae treatment at the National Burns and Plastic Surgery Centre in the University Hospital Centre in Casablanca, Morocco. Our survey concerned 65 patients aged 2 to 70 years (45 men and 20 women) on whom we performed a total number of 143 surgical operations in 105 hands. The sequelae were located in the back of the hand in 57 cases, followed by the commissures in 43 cases. Various reconstruction methods were used, notably skin graft (58 cases) and local flaps (32 cases). We assessed the patients' level of satisfaction with the results achieved using the different methods and found that, with regard to skin graft, 94% were satisfied with the results achieved in the back of the hand, 90% with the local flaps in the first commissure, and 95% with distance flaps. With regard to reconstruction of the thumb, 100% of the patients treated with pollicization of a finger declared their satisfaction and 75% of those treated with transfer of the second toe.

[Not Available]. / Sequelles de Brulures au Centre Hospitalier Universitaire Ibn Rochd de Casablanca: Aspects Epidemio-Cliniques.

Il s'agit d'une étude épidémiologique des séquelles de brûlures à propos de 100 cas colligés au service de chirurgie réparatrice et de brûlés du centre hospitalier universitaire Ibn Rochd (Casablanca). Les adultes représentent 55% de la population étudiée, l'âge moyen global est de 20 ans. Le sexe féminin est le plus touché avec 61% des cas. Les brûlures survenues à domicile sont les plus fréquentes avec 80%. L'agent causal le plus incriminé est la petite bouteille de butane avec 44,4%. Plus de la moitié de la population brûlée (55%) sont accueillis initialement au niveau d'hôpitaux régionaux. Le délai de cicatrisation moyen de 7 mois et 11 jours et par conséquent les séquelles mineures (dyschromie dans 90% des cas et prurit dans 49% des cas) et majeures (rétractions dans 86% et l'hypertrophie dans 51%) sont fréquentes. La répartition globale des séquelles montre une prédominance du segment cervicocéphalique avec 89% des cas et des membres supérieurs dans 82% des cas. Les différents aspects anatomocliniques essentiels ont été décrits au niveau de chaque segment corporel. Nos résultats ont été comparés aux données de la littérature, ce qui nous amène à considérer qu'une large campagne de prévention couplée à une meilleure prise en charge initiale, précoce, bien conduite et multidisciplinaire permet non seulement de réduire le nombre de séquelles mais aussi de diminuer leur sévérité.

[Not Available]. / Les Sequelles de Brulures: Epidemiologie et Traitements.

An epidemiological study was performed in the Burns and Reconstructive Surgery Centre in Casablanca University Hospital (Morocco). A one-hundred patient cohort was studied, with adults accounting for 55% of the cases; the average age was 20 years. Females represented 61% of the cohort. More than 50% of the patients were seen first in regional hospitals. The average time before healing was 7 months and 11 days, and minor and major burn scarring was frequent. The clinical epidemiology is described for each topographical body part and the results are compared with those in the literature. Various therapeutic approaches, using medical and surgical treatment, were followed. It is shown that prevention is still the best approach in the treatment of burns sequelae.

[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]. / Brulure par Foudre. A Propos d'une Observation.

Aussi loin que l'on remonte dans la littérature, on retrouve des récits relatant des accidents consécutifs à la fulguration chez l'homme. La foudre était alors associée à la colère des dieux ou à la notion de châtiment. La fulguration correspond à un transfert d'énergie entre un cumulonimbus de charge négative et un objet de charge positive se trouvant au niveau du sol. Les lésions déterminées sont à la fois thermiques et électrothermiques. Bien que l'arrêt cardiorespiratoire soit une cause bien documentée de décès, la plupart des cas rapportés dans la littérature décrivent un éventail très disparate des séquelles qui surviennent suite à cet accident. Les Auteurs rapportent le cas d'un patient atteint par la foudre en insistant particulièrement sur les complications neurologiques qui sont survenues en cours d'évolution. Se basant sur cette observation et sur une revue de la littérature, les Auteurs soulignent que le pronostic des patients atteints par la foudre est plus favorable que généralement rapporté.

[The Marjolin's ulcer, destiny of a unstable scar. About 54 cases of burn's sequelae]. / L'ulcère de Marjolin, destinée d'une cicatrice instable. A propos de 54 cas de séquelles de brûlure.

Through a study of 54 cases of malignant transformation on burn's scar, collected during a period of 8 years, the authors underline the particularities of this tumor, reported at the literature such as the preponderance of spinocellular carcinoma as histological type, the high rate of lymphatic metastasis and recurrence, and also the poor prognosis. In addition, the authors underline the non-rare character of this affection, whose incidence is correlated to the level of medication; it's occurring in younger patients, and its short delay of transformation. The treatment is based on prevention by a correct management of the initial burns, the cure of any instable scar, and a regular surveillance. The biopsy should be realised in case of suspicion of degeneration. The radical treatment must be initially aggressive, consisting on large excision associated eventually to radiotherapy. This treatment must be integrated in an elaborating therapeutic strategy, taking on consideration the evolutive potentiality of these tumors in order to improve chances of recovery and survival.

[The use of preputial skin as cutaneous graft after circumcision. Report of 30 clinical cases]. / Utilisation de la peau préputiale comme greffon cutané après circoncision. A propos de 30 cas cliniques.

Through a study of 30 clinical cases, collected at the service center of plastic surgery and burns in Averroes University hospital at Casablanca, the authors underline the interest of using preputial skin as full-thickness skin graft for the treatment of burns and their sequelaes in non-circumcised boys, whose age ranged from one to four years. At this age, they are more exposed to domestic accidents. The preputial skin graft gives the advantage of the absence of scare prejudice at the donor site each time the circumcision is possible; and provides a skin of good elastic quality avoiding secondary retraction with a very favorable rate of graft intake. Although the application of this technique for other affections is possible, but remains limited by the hyperpigmentation of the graft.