La prise en charge d´un afflux massif de brûlés en provenance d´une prison pour mineurs au Maroc.

Massive influx of burns (thermal, chemical or electrical) is a potential crisis situation in the world in peacetime. In fact, burn is one of the most frequently encountered injuries following natural or human disasters. The management of a massive influx of burn victims is considered to be a real challenge, not only from a medical point of view but also from a logistical and organizational point of view. It is an exceptional event requiring exceptional organization and planning in advance, including systematically training medical and paramedical personnel, without forgetting ambulance and fire workers as they will be the first to arrive at the scene. Planning must necessarily include equipment for fast and effective support. We will present our experience in managing a massive influx of burns from a juvenile detention centre. We share it in order to help establish a better plan to deal with these rare but challenging situations.

[Management of eyelid carcinomas: Retrospective bicentric study of 64 cases and review of the literature]. / Prise en charge des carcinomes des paupières : étude bicentrique rétrospective sur 64 cas avec revue de littérature.

PURPOSE: To study the epidemiologic, clinical and histological aspects of eyelid carcinomas in our context, and to evaluate our surgical management on an oncological, functional and aesthetic level. PATIENTS AND METHODS: This work is a retrospective bicentric study extended over a 5-year period between January 2009 and December 2013, including 64 patients with eyelid carcinoma undergoing surgery in the Plastic and Reconstructive Surgery Department at the Avicenne University Hospital of Rabat and in the ENT/Head and Neck Surgery Department at the Hassan II University Hospital of Fez. RESULTS: The study included 25 men and 39 women with a mean age of 60.6 ± 15.33 years. Advanced age and chronic sun exposure were the most important risk factors. The most commonly involved site was the lower eyelid (53%). Histological examination emphasized the very high prevalence of basal cell carcinoma (90.62%). Surgical treatment was performed in all our patients followed by an extemporaneous and/or standard histological examination of the surgical specimen. Exenteration was performed in one patient with adjuvant radiation therapy. Reconstruction incorporated a variety of techniques, of which total skin graft and Mustardé flap were the most common in our series. Aside from a few complications, the postoperative results were satisfactory for the majority of our patients. CONCLUSION: Malignant tumors of the eyelids, of which basal cell carcinoma is the most common, pose a therapeutic problem where surgery remains the most utilized treatment option. The best treatment is prevention and diagnosis of early lesions to improve prognosis and to avoid worse outcomes.

[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.

[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.

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.

[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.

[The "necktie lasso": a new technique for the simultaneous treatment of Wartenberg's sign and claw deformities in the hand due to ulnar nerve palsy]. / Le "lasso en cravate': une nouvelle technique pour le traitement simultané du signe de Wartenberg et des déformations en griffe des mains atteintes de paralysies cubitales.

The "necktie lasso" is a new technique that allows the simultaneous active treatment, of both Wartenberg's sign and claw deformity of the fifth and the fourth digits in the hand with ulnar nerve palsy. The flexor sublimis of the fourth digit is taken by a palmar approach. It is then divided into two strips up to the proximal part of the palm; The radial strip is used as a classical "direct lasso" to treat the claw deformity of the fourth digit; The ulnar strip is wound around the base of the fifth digit by a palmar and dorsal approaches at the level of the proximal phalanx, like a necktie, being medial to its radial pedicle, dorsal and superficial to its extensor apparatus, then lateral to its ulnar pedicle; It is then recovered in the palm and sutured to itself. From September 1998 to April 2003, this technique has been used in eight patients aged between 21 and 35 years old and suffering from post traumatic low ulnar nerve palsy. It was always very effective in dealing with Wartenberg's sign: the active adduction of the fifth digit appearing at the start of flexion. The claw deformity of the fourth and fifth digits was equally actively corrected. No complications are reported in this series. With a mean follow-up of 3 years there was no recurrence of any of the deformities.

[The protected tendinous graft in zone 2 or fibroblast trap]. / La greffe tendineuse protégée en zone 2 ou le piège à fibroblastes.

INTRODUCTION: We present a simple technique for preventing adhesions to tendon grafts in zone 2. A silicone tube is cut longitudinally and the third of its diameter is removed. It is then introduced under the pulley with the slot towards the skeleton. The tendon graft is introduced into this tube which will protect it from adhesions except at the slot level where fibroblasts create a new vasculature. MATERIALS AND METHODS: Between April 2002 and April 2003, we have used this technique in three patients, two in their thumbs and one in the long finger. In the Boyes classification, one thumb lesion corresponded to stage 1 and the other two cases to stage 4. The main pulleys were preserved. The tube measured 12 cm in length, and extended from the proximal juncture to the distal one (Pulvertaft technique). After 5 weeks of strict immobilization, the tube was withdrawn and the patients began active mobilization. RESULTS: After 8 weeks, comparison of the results with the opposite hand showed: Normal extension in all cases. Flexion deficit of 15 degrees in the thumb interphalangeal joints. Flexion deficit of 20 degrees in the proximal and distal interphalangeal joints of the long finger. There were no reported complications. With a mean follow-up of 1 year, these results were stable. CONCLUSION: These results support the contention that a good blood supply to the tendon and a good gliding surface have been developed with this technique. The tube seems to work as a fibroblast trap and blocks harmful adhesions.

[The bilobed flap: a very efficient method in aesthetic reconstruction of small skin defects at the alar and tip regions of the nose]. / Le lambeau bilobé : un moyen très efficace dans les reconstructions esthétiques des petites pertes de substance cutanées de la pointe et de l'aile du nez.

From October 1996 to January 2001, 20 patients (14 men and six women) ranging from 36 to 75 years old have been treated for their small skin defects of the nose by using the bilobed flap. These skin defects were located in 15 cases at the alar region and in five cases at the tip region. They were secondary to the resection of basal cell carcinoma in 17 cases and benign tumors in three cases. Their diameter ranged from 8 to 17 mm and in all these cases there was no involvement of the lining or cartilage. The design used for this bilobed flap was the Zitelli one, based on some mathematical principles; its base was medial or lateral depending on the site of the defect. With this method, the skin defects were reconstructed esthetically without any distortion of local anatomy of the nose with skin having the same color, texture and thickness. With an average of 28 month follow-up, all these reconstructions were stable with discreet scars and without the trapdoor phenomenon. No complications were reported. Esthetic reconstruction of such subunit nasal skin defects is easily done by this technique and is better than that obtained by the majority of others methods.

[The fasciomusculocutaneous flap at the leg. About 9 clinical cases]. / Le lambeau fasciomusculocutané de jambe. A propos de 9 cas cliniques.

The fasciomusculocutaneous flap at the leg (FMC) include a muscle strip in the classic dissection of the fasciocutaneous flap (FC); this muscle survives only by the musculocutaneous vessels perforators. This muscle improves the trophic quality of the classic FC flap and allows him to bring easily muscle to the lower third of the leg and sole of the foot. From october 96 to january 2001, 9 posterior FMC flaps have been used in 9 men, their ages were between 22 and 61-years-old, 8 of these flaps were distally based and 1 was proximally based. The muscle strip came from the medial gastrocnemius muscle, its lengh and its width corresponded to the dimension of this muscle but the depth has never exceeded 10-12 mm. The skin defects have a diameter ranging from 7 to 10 cm and were localised in 3 cases in the sole of the foot, in 5 cases in the lower third of the leg with 1 case of tibial osteomyelitis and in 1 case in the external part of the knee. All these defects were secondary to trauma. No complications were reported with this technique. There was no vascular problems with the muscle strip: its bleeding was checked at the operating room and at 3 weeks when the pedicle was severed. All these patients were hospitalized between 4 and 5 weeks. With an average of 30 months follow-up all the defects covered were very satisfying and the case of the osteomyelitis was healed. There is no functional sequellae and the aesthetic sequellae are those of the classic FC flaps at the leg.

[Is a dynamic or stable technique needed for metacarpophalangeal joints of the hand in ulnar nerve palsy?]. / Faut-il réanimer ou juste stabiliser les métacarpophalangiennes des doigts et du pouce des mains cubitales?

INTRODUCTION: It seems interesting to choose between the dynamic and the static techniques for the rehabilitation of the hand suffering from an ulnar nerve palsy on the basis of the grasp (F1) and pinch (F2) strengths which are important in this rehabilitation. METHODS: From june 1997 to december 2001, 30 ulnar palsies all post traumatic with non complicated claw deformities have been collected and distributed in three groups of ten patients. In the group A only the static techniques have been used on the MP joints of the fourth and fifth digits and the thumb; in the group B only the dynamic techniques have been used on the fourth and fifth digits, on the flexor pollicis brevis and on the first dorsal interosseous muscle; in the group C, the MP joint of the thumb has been stabilized and dynamic techniques have been used on these two muscles, the MP joints of the fourth and fifth digits have been only stabilized. The techniques used in this study were among the most popular. The grasp and pinch strengths were measured by a mechanical dynamometer at the preoperative period and at third and sixth postoperative month. RESULTS: At sixth month, in the group A, F1 didn't change and F2 has increased by 9%; in the group B, F1 has decreased by 24% without recovery of the preoperative value and F2 has increased by 13%; in the group C, F2 has increased by 19%. DISCUSSION: For a reconstruction of an useful hand in an ulnar nerve palsy, the best solutions seem: for the fourth and fifth digits: simple stabilization of the MP joints for the thumb: an association of this stabilization and a rehabilitation of some muscles involved in the pinch prehension.

[Iterative surgery for goiter]. / Les réinterventions après thyroïdectomie pour goitre.

AIM: Identify and resolve problems related to iterative surgery for goiter. PATIENTS AND METHOD: Fifty-nine patients who underwent surgery for recurrent benign goiter between 1990 and 1999 were included in the study. RESULTS: Forty-two patients had lobectomy and isthmusectomy (71.2 and 17 patients had subtotal thyroidectomy (28.8%). The delay from initial surgery to recurrence was less than 5 years for 44% of the patients and was more than 10 years for 17.8%. There was no post-operative mortality and no recurrent laryngeal nerve injury. Early post-operative hypocalcemia occurred in 2 patients (3.3%). CONCLUSION: The goal of revision surgery for recurrent goiter is total thyroidectomy. Prevention is a rational management scheme for thyroid nodules.