Les brûlures électriques par haut voltage de l'enfant, à propos de trois cas.

High-voltage electrical burn injuries are rare emergencies in pediatric units and always associated with a poor prognosis. Recklessness, lack of knowledge about electric currents and the lack of safety around public electricity infrastructures are the three main factors contributing to the occurrence of high-voltage electrical accidents in children. Mortality is due to acute cardiac and renal complications, and trauma associated with falls. Secondary evolution is dominated by the risk of infection and the severity of functional sequelae. Early diagnosis and prompt treatment is needed to prevent these complications. Therapeutic management is based on early resuscitation and surgical management of tissue damage. We report three cases of high-voltage electrocution in children, with electro-thermal burns associated with severe head injury in one case, and myocardial damage and a compartment syndrome with severe functional sequelae in the other two. These three case reports are an opportunity to discuss literature data.

[A rare cause of anosmia: nasosinusal tuberculosis]. / Une cause rare d'anosmie: la tuberculose nasosinusienne.

We report the case of a 46-year-old-woman who presented with anosmia and nasal obstruction. Primary nasal tuberculosis was discovered. Primary nasal tuberculosis is very rare. Women are more touched than men. Symptomatology is often unilateral with nasal obstruction, anterior rhinorrhea or epistaxis. Diagnosis relies on the anatomopathologic and bacteriological examinations. The treatment is mainly medical based on antituberculosis drugs. In the light of this case report, a review of the literature was made.

Report of the First Clinical Case of a Moroccan Kabuki Patient with a Novel MLL2 Mutation.

Kabuki syndrome (also known as Niikawa-Kuroki syndrome) is a rare autosomal disorder, characterized by an unusual face, short stature, skeletal, visceral and dermatoglyphic abnormalities, cardiac anomalies, mental retardation, and immunological defects. Point mutations and large intragenic deletions and duplications of the mixed lineage leukemia 2 (MLL2) and exons deletions of lysine demethylase 6A (-KDM6A) genes have been identified as its underlying causes. We report on the first description of a Moroccan Kabuki syndrome patient with typical facial features, developmental delay, finger pads, and other anomalies carrying a novel splice site mutation in the MLL2 gene that produces a truncated and likely pathogenetic form of MLL2 protein.

[Necrotizing fasciitis of the thoracoabdominal wall complicating Dujarier's bandage: a case report]. / Fasciite nécrosante compliquant un bandage de Dujarier: à propos d'une observation.

The necrotizing fasciitis (NF) means a serious infection of the subcutis, the fascia and superficial dermis secondarily. We report the case of a patient with cellulitis NF of the thoracoabdominal wall complicating Dujarier's bandage. It was monobacterial NF caused by ß hemolytic streptococcus, whose development was supported through an appropriate medical and surgical care. The situation mentioned is the occurrence of secondary infection of skin necrosis occurred in the bandage too tight opposite the support zone of the elbow on the trunk. We point out, through this case, the importance of the medicosurgical and also the importance of making any thoracoabdominal bandage, which could lead, if it is tight, a pressure sore can be a door entry for any NF plus a late diagnosis.

[Self-closing flaps in the treatment of scalp burns due to high-voltage electricity]. / Lambeaux autofermants pour le traitement des brulures electriques du scalp par haut voltage.

Electrical burns caused by high voltage are responsible for extensive tissue damage. This damage continues in the days following the accident because of the heat deriving from the Joule effect and vascular microthrombosis. In such cases of destruction of the periostum and the calvarium we use coverage flaps. From June 1997 to June 2008, 15 patients were treated for loss of scalp substance due to high-voltage electric burns. The loss, in the tonsural region and varying in size from 9 to 11 cm, was reliably covered per primam in the first week following the accident using axial and multiple coverage flaps. We report the experience of the Division of Plastic Surgery, Ibn-Sina, Rabat, Morocco.

[Electrical burns suffered by copper thieves]. / Les brulures electriques chez les voleurs de cuivre.

Thefts of copper appear to have been on the increase for some time owing to its high resale price. This has led to an increase in the number of high-voltage electrical accidents (HVEA). Such accidents are very serious because they cause deep burns along the neurovascular axis. A report is presented describing a series of nine patients presenting HVEA admitted to the Ibn Sina Hospital Plastic Surgery and Burns Division in Rabat, Morocco, with a study of the epidemiological, clinical, and therapeutic aspects. The patients all belonged to the young and active sector of the population. The burns were secondary to contact with high-voltage cables occurring during the attempted stealing of copper by stripping electric conductors in transformers (67% of the cases) and in attempts to cut overhead lines supplying electric trains on the railway network (33%). Electrothermal treatment of the lesions required repeated surgery with amputation and disarticulation of necrotic limb segments (67% of the cases), the consequences of which were marked by disabling functional sequelae. Preventing this type of HVEA remains fundamental.

[Severe burns of lower limb due to association of hot water and citrullus colocynthis]. / Brulure grave du membre inferieur par l'association d'eau chaude et de citrullus colocynthis.

The case is reported of a patient suffering from severe burns through having used Citrullus colocynthis as a medicinal plant together with hot water. This led to carbonization of the foot and to its amputation. A description of the plant and its toxicity is given.

[Expanded scalp flap in cicatricial areas affected by burns sequelae - an observation]. / Lambeau Expanse du Cuir Chevelu dans la Couverture des Alopecies Cicatricielles sur Sequelles de Brulures. A Propos d'une Observation.

Les séquelles esthétiques des alopécies cicatricielles sur séquelles de brûlures sont responsables de préjudices empêchant parfois la réinsertion sociale du patient, surtout chez les sujets de sexe féminin. Le cuir chevelu permet la réalisation de lambeaux permettant de couvrir ces alopécies. Les Auteurs décrivent le cas d'une jeune patiente victime d'une alopécie cicatricielle sur séquelles de brûlures chez qui ils ont réalisé un lambeau expansé du cuir chevelu et mettent le point sur la prise en charge de ces lésions à travers ce cas clinique et une revue de littérature.

[Skin grafting in the treatment of hand burns sequelae in relation to 152 cases. Report from Department of Plastic Surgery, University Hospital Ibn Sina]. / La Greffe de Peau dans le Traitement des Sequelles de la Main Brulee. A Propos de 152 Cas - Experience du Service de Chirurgie Plastique du Centre Hospitalier Universitaire Ibn-Sina, Rabat, Maroc.

La main est fréquemment exposée aux brûlures, entraînant des séquelles esthétiques et fonctionnelles. Le traitement de ces séquelles est surtout chirurgical et consiste en la greffe de peau, dont le type dépend de la localisation de la brûlure et du type des séquelles. Dans ce travail rétrospectif, nous rapportons une série de 152 cas de brûlures des mains colligés au service de chirurgie plastique du Centre Hospitalier Universitaire Ibn-Sina de Rabat sur une période de dix ans, allant de 1998 à 2007. Les indications thérapeutiques dépendent du type de séquelles et de la localisation de la brûlure. En tout, 97 patients ont bénéficié d'une greffe cutanée, dont 76% par greffe de peau totale, 21% par greffe de peau demi-épaisse et 3% par peau fine. Les séquelles des brûlures des mains posent un problème thérapeutique majeur, malgré la diversité des procédés chirurgicaux, d'où l'intérêt de la prévention.

[Münchausen syndrome by proxy. A case report]. / Le syndrome de Münchausen par procuration. A propos d'un cas.

The plastic surgeon rarely encounters patients with factitious disorders. The syndrome of Münchausen by proxy is a part of it. We put the point on this syndrome through a clinical observation of an eight-year-old girl victim of parental abuse.

[Solitary fibrous tumor of the scalp: a case report]. / Tumeur fibreuse solitaire du cuir chevelu : a propos d'un cas.

The solitary fibrous tumor is a rare tumor, ubiquitous, mesenchymatous essentially affecting serosal surfaces. The location in the scalp is exceptional. We report a case of tumor in left occipital scalp discovered after recurrence of a tumor initially taken for a lipoma. The motive for consultation was mainly aesthetic. The pathological examination is the main element of diagnosis. The assumption is based on a large lumpectomy and an extended and regular clinical monitoring. The forecast is favourable with a decline of one year. However, relapses may occur in the long-term and there are malignant forms.

Finger avulsion injuries: a report of four cases.

Injury that occurs to a finger wearing a ring though rare can have grave consequences. It is a preventable injury which has a peculiar mode of trauma that is usually occupational. Injury ranges from simple contusion to degloving of soft tissues to traumatic amputation. We hereby report our experience of four cases of finger avulsion injuries due to a ring and discuss their variable clinical presentation and individualized management.

[Not Available]. / L'Attitude Chirurgicale dans les Brulures Electriques Graves par Haut Voltage: À Propos de Deux Cas.

Devant une brûlure électrique grave, deux attitudes chirurgicales se distinguent: 1. une attitude conservatrice; 2. une attitude d'amputation. A la lumière de deux observations, les Auteurs discutent les avantages et les difficultés de la mise en oeuvre de chaque attitude.

[Not Available]. / Les Brulures Electriques par Haut Voltage - A Propos de 10 Cas.

Les accidents électriques par haute tension (AEHT) provoquent des brûlures profondes par effet Joule le long des axes vasculo-nerveux entre les points d'entrée et de sortie, qui sont le siège de lésions délabrantes. Les Auteurs rapportent une série de dix cas d'AEHT admis au service de chirurgie réparatrice et de brûlés de l'Hôpital Ibn Sina de Rabat à travers laquelle ils étudient les caractéristiques épidémiologiques, cliniques et thérapeutiques. Tous les patients étaient des adultes de sexe masculin dont l'âge moyen était de 31 ans. Dans 70% des cas, ces brûlures étaient secondaires à un contact avec les distributeurs d'électricité avec une surface brûlée inférieure à 20%. Le traitement des lésions électrothermiques a nécessité des interventions itératives avec amputation des segments de membres nécrosés dans 70% des cas, dont les suites étaient marquées par des séquelles fonctionnelles invalidantes. La prévention des AEHT, en particulier pour les accidents du travail au sein des professions exposées, reste fondamentale.

[A simple way to secure the distally based fascio-cutaneous flap of the leg: the lesser sapheneous-greater sapheneous vein anastomosis. Report of 15 clinical cases]. / Sécurisation des lambeaux fasciocutanés de jambe à pédicule distal par l'anastomose saphène externe-saphène interne. A propos de 15 cas cliniques.

PURPOSE: The distally based fasciocutaneous flaps of the leg are very useful for the treatment of skin defects at the lower third of the leg and the foot, but the venous congestion due to the reverse flow can be responsible of necrosis at the distal part of the flap. The anastomosis of the lesser saphenous vein which is included in the flap's dissection to the greater saphenous vein near the defect avoid this venous congestion and the necrosis of the most useful part of the flap for the coverage of these defects. MATERIAL AND METHODS: From January 1999 to June 2005, 15 patients aged between 22 and 64 years old have benefited for the treatment of soft tissue defects secondary to trauma with a mean diameter of 7 x 10 cm and located in 7 cases at the lower third of the leg and in 8 cases at the posterior side of the heel, from distally based posterior fasciocutaneous flaps where the venous reverse flow has been changed in a physiological one by the terminolateral anastomosis between the lesser and greater saphenous vein. The dissection of these flaps was classical except that the lesser saphenous vein was dissected 6 cm beyond the proximal part of the flap in the popliteal region. RESULTS: In all these flaps, there was no venous congestion and no arterial problems. With a mean follow-up of 40 months, the coverage's quality of these defects was very satisfactory. No sequellae are reported. CONCLUSION: The anastomosis between the lesser and the greater saphenous veins seems to eliminate the main source of failure of the distally based fasciocutaneous flap of the leg and can reinforce the indications of these flaps for the treatment of such defects.

[Liposarcoma of the thumb]. / Liposarcome du pouce.

Liposarcoma is the most common malignant deep soft-tissue tumor in adults. however, primitive cutaneous liposarcoma is very rare. We report the observation of a patient who presents a liposarcoma of the thumb.

[Extensor digitorum brevis muscle flap: its help in coverage of distal foot defects. Report of six cases]. / Le lambeau du muscle court extenseur des orteils à flux rétrograde au secours des pertes de substance distales du pied. A propos de six cas.

From January 1997 to march 2002, six extensor digitorum brevis muscle flaps have been used in four women and two men. Their ages were between five and 65-years-old. The defects were localised in the hallux in three cases, the dorsum of foot in one case, the other toes in one case and the external border of foot in one case. The defects were secondary to burn retraction in four cases, secondary to trauma in one case and secondary to osteomyelitis in another case. All the flaps were elevated on the distal dorsalis pedis artery with a retrograde flow. With an average of four years follow-up, all defects covered were very satisfying and there is no functional sequellae.

[Surgical management of cutaneous pathomimia. A report case]. / Prise en charge chirurgicale de la pathomimie cutanée. A propos d'un cas avec revue de la littérature.

UNLABELLED: Cutaneous pathomimia is a behaviour disorder witch interest the skin. In some cases, self-mutilation can be serious and require a surgical treatment. CASE REPORT: A 60 year old woman consults for extensive scar interesting the face and the scalp and realising the aspect of burn face in cicatricle level. The treatment consisted on excision and skin graft. The patient was addressed to Psychodermatology consultation. Authors show the place of plastic surgery in management of cutaneous pathomimia.