[Long-term results of plantar skin grafts versus skin grafts of hairy areas for covering loss of skin substances on the palmar surface of the fingers, palm of the hand and sole of the foot in patients with black skin. Prospective cohort study of 123 total skin grafts]. / Résultats à long terme des greffes de peau plantaire versus greffes de peau des zones velues pour la couverture des pertes de substances cutanées de la face palmaire des doigts, de la paume de main et de la plante du pied chez les patients à peau noire. Étude de cohorte prospective de 123 greffes de peau totale.

CONTEXT: Despite the use of total skin grafting in the treatment of loss of skin substances on the palmar surface of the fingers, the palm of the hand and the sole of the foot, the data published in the literature on long-term results in black-skinned patients are non-existent. METHODS: The present study, filling this gap, used data from a prospective cohort of 123 total skin grafts performed on 93 black African patients who benefited from plantar skin grafts versus skin grafts from hairy areas to cover loss of skin substances. of the palmar surface of the fingers, the palm of the hand and the sole of the foot. This study covers a period of 163 months. RESULTS: Sixty-four grafts of hairy areas were carried out in 52 patients, 29 of whom were male and 23 female, for a M/F sex ratio of 1.3; and 59 plantar skin grafts in 41 patients including 21 males and 20 females, M/F sex ratio of 1. The digital palmar surface was the most recipient of the plantar graft, i.e. 35.5% of cases. After a post-operative follow-up of at least 12 months, patients or their entourage judged the functional and aesthetic results of plantar skin grafts to be better and acceptable, unlike the results of hairy area grafts. The texture and color are even better if the total skin graft is taken from an identical histological area. CONCLUSION: In view of these results, we recommend a plantar skin graft for black-skinned patients to cover losses of skin substances on the palmar surface of the fingers, the palm of the hand and the sole of the foot, if indicated.

Time to removal of sutures from the palmar surface of the hand in dark-skinned patients: Results in a prospective cohort of 146 hands.

The objective of this study was to estimate the time to removal of a suture from the palmar surface of a dark-skinned adult hand. A descriptive and analytical study included a cohort of 146 patients, 57% male, with a mean age of 37 ± 14 years, covering a period of 10 years. The mean time to removal of sutures on the palmar surface of the dark-skinned adult hands was 21 ± 2 days. Complete epithelialization of the suture path was the clinical indication for the ideal day for removal. After removal, closure was total in 90% of cases (132 hands) and partial in 9% (14 hands). The day of suture removal was significantly (p = 0.006) related to wound healing (complete closure). Eighty-five percent of patients without complete wound closure at suture removal had history of use of skin-lightening products. Tobacco use significantly lengthened time to suture removal (p < 0.001). There was a correlation between patient age and time to suture removal. On multivariate analysis, three factors were predictive of suture removal later than day 21: being a manual worker (44% of patients) (p 0.006), suture location in a palmar fold area (<0.001) and the age of patient, the 41-50 years (p = 0.001) and >50 years (p < 0.001).

[Second ear piercing for aesthetic purposes and appearance of pathological scars in negroids: About 172 observations in an endemic area of keloids]. / Deuxième piercing auriculaire à but esthétique et apparition de cicatrices pathologiques chez les négroïdes : à propos de 172 observations dans une zone endémique de chéloïdes.

This is a transverse and retrospective descriptive study carried out on a quantitative and qualitative component on pathological scars after a second ear piercing for aesthetic purposes in a Negroid female population from an endemic area of keloids. For a period of 10 years (from January 1, 2010 to December 31, 2019), we observed 172 patients with pathological ear scars after a second piercing for aesthetic purposes including 65.7% of female students and 22.1% of students. Clinically, we had 143 (83.1%) patients with keloids and 29 (16.9%) with hypertrophic scars. The average age of the second piercing was 22.62 years; 98 (57%) patients had single lesions on the pierced ear and 74 (43%) multiple lesions; 168 (97.7%) had no family history of pathological scars. Our patients from an endemic area of keloids did not develop pathological scars during the first piercing but all develop pathological scars after the second piercing. Several risk factors could be accused: heredity, environment, race, age, gender, wearing of poor-quality jewelry, infection, disruption of the healing process caused by the first piercing, mechanical tension caused by the new ornamental object. However, none of these assumptions has been verified. In the meantime, we do not recommend that at risk negroid subjects, originating from areas with high endemicity of keloids, a second ear piercing for aesthetic purposes.

Treatment of elephantiasis of the leg by fasciotomy and lymphangiectomy with skin preservation in a resource-limited setting: a case report and review.

The author reports the surgical management of a patient with elephantiasis of the leg in the Democratic Republic of Congo. A fasciotomy and lymphangiectomy with skin preservation, combined with compression therapy, resulted in significant cosmetic, functional, and social improvement. Although challenging in a resource-limited setting, development of surgical management may make it possible to reduce beliefs that elephantiasis is incurable or due to witchcraft and may reduce time to consultation.

Silicone infusion tubing instead of Hunter rods for two-stage zone 2 flexor tendon reconstruction in a resource-limited surgical environment.

The authors describe their experience using silicone infusion tubing in place of Hunter rods for two-stage zone 2 flexor tendon reconstruction in a resource-limited surgical environment. This case report features a 47-year-old, right-handed man who had no active PIP and DIP joint flexion in four fingers of the right hand 5 months after an injury. During the first repair stage, the A2 and A4 pulleys were reconstructed using an extensor retinaculum graft. An infusion tube was inserted instead of Hunter rods. During the second stage, formation of a digital neo-canal around the infusion tubing was observed. The infusion tubing was removed and replaced with a palmaris longus tendon graft according to the conventional technique. Physiotherapy and rehabilitation followed surgery. At 6 months, very significant progress had been made with complete recovery of PIP and DIP flexion in the four fingers.

[Not Available]. / Traitement des séquelles de brûlures de la main dans les pays à ressources limitées ; notre expérience en république démocratique du Congo.

Burn injuries to the hand are still common in low-income countries. Between December 1st 2010 and May 1st 2014, 32 patients, representing 38 hands, were admitted and treated at the University Clinics of Kinshasa in the Democratic Republic of Congo (DRC). We observed 22 patients (69%) in the juvenile age group (under 18 years old) and 10 patients (31%) in the adult age group (18-59 years). We did not observe any patients in the senior age group (60 years and over). In the juvenile age group, those aged from 1 to 5 years old were the most affected, comprising 13 patients (40%). Accidents occurred mainly at home (72%). The most common burn etiologies were thermal injuries caused by flame (51%) and scalds (34%). Contractures were the most frequently occurring lesions (84%). Overall dorsal retraction, known as "claw hand", was found in 40% of patients, and was associated with keloid and hypertrophic scars in 84% of cases. Excision and grafting were performed in 43.7%, local flaps in 43.7% and distant flaps in 12.5% of cases. On discharge from hospital, 84% "good" results were observed. Follow-up lasted 18 months. This study demonstrates the feasibility of reconstructive surgery in sequelae of hand burns, despite limited resources. However, the challenges in low income countries with limited resources are numerous: poor access to current techniques of plastic surgery, inadequate initial burns management, and poverty.

[Stab wounds of the hand and forearm due to Kuluna in Kinshasa (Democratic Republic of Congo): types of injuries and treatment]. / Plaies de la main et de l'avant-bras par arme blanche dues au phénomene Kuluna à Kinshasa (République Démocratique du Congo): types de lésions et traitement.

Democratic Republic of Congo (DRC), a particular form of juvenile delinquency and insecurity intensifies in the city of Kinshasa. This is the phenomenon Kuluna. It is organized gangs equipped with machetes and other weapons. The main objective of this study is to know the phenomenon Kuluna and describe the upper limb injuries caused by machetes, while insisting on the specifics of the management of these lesions in our communities. This retrospective descriptive study examines 14 cases of wounds of the hand and forearm due to stab phenomenon Kuluna, in Kinshasa. It covers the period from 1 November 2010 to 1 November 2013. Among the 14 patients with lesions in the hand and forearm admitted and treated at the Unit of Plastic Reconstructive and Aesthetic Surgery, Hand Surgery and Burns, University Clinics of Kinshasa to attacks due to the phenomenon Kuluna. We have 11 men and 3 women. The average age was 33, 5 years (extremes of 21 and 56 years). The right upper limb is reached that the left upper limb, respectively 12 patients and 2 patients. The lesions are localized to the wrist in the majority of cases (10 patients) in the palm of hand and in 3 patients in the fingers in 1 patient. The palmar surface is reached (10 cases) and the dorsal (4 cases). Zone 5 of the International Classification of flexor and Zone 8 topographic classification extensors at hand are the predilection sites of lesions respectively the palmar surface (6 out of 10) and the dorsal (2 case 4). The median nerve at the wrist is cut in half the cases. On bone lesions localized to the forearm, we observed a high incidence of fracture of the ulna (62.5%). The treatment begins with the stabilization of bone pieces, gestures revascularization and nerve sutures and suture tendon and finally skin coverage. Rehabilitation was mandatory, she supervises the actions of repair and it continues until the recovery of function.

[Buruli ulcer in the health districts of the Democratic Republic of Congo from 1950 to 2013: literature review and new distribution map]. / Ulcère de Buruli dans les zones de santé en République démocratique du Congo, de 1950 à 2013 : revue documentaire et nouvelle carte de distribution.

This paper describes the current distribution of cases of Buruli ulcer (BU) by highlighting health districts that are endemic and suspected to be endemic, based on the studies, surveys, and activity reports published from 1950 to 2013. We define as endemic any health district with BU patients positive by PCR, whether or not positive on a Ziehl-Neelsen (ZN) test, culture or histologic sample. A district is defined as suspected to be endemic when it is a historical BU area, has BU clinical cases and/or patients with positive ZN, but negative PCR. Of the 515 health districts in the DRC, 17 were found to be endemic (3%) and 26 suspected to be endemic (5%). In most cases, former focal areas, described before 1974, remain currently active. New focal points were found along the Kwango River in the province of Bandundu. We also discovered the extension of former BU focal areas to neighboring health districts in the provinces of Bas-Congo, Bandundu, and Maniema. The need for diagnostic confirmation by PCR appears to be a requirement and a priority, not only in all former historical focal areas but also in the health districts newly suspected to be endemic.

[Necrotizing fasciitis: study of 17 cases presenting a low mortality rate]. / Dermo-hypodermite bactérienne nécrosante avec fasciite nécrosante : à propos de 17 cas présentant un faible taux de mortalité

UNLABELLED: Necrotizing fasciitis is a hypodermis, muscular fascia then dermis necrotizing infection. OBJECTIVE: The originality of this study is to present a series of necrotizing fasciitis treated and followed these last five years, and to compare the therapeutic results with those of the literature. PATIENTS AND METHODS: We led a retrospective study on the patients treated for necrotizing fasciitis between 2005 and 2009 by bringing together the demographic and clinical data, the bacteriological examinations and the results of management. Follow-up data from these patients during period of study (five years) were notified. RESULTS: Seventeen patients were treated (11 men and six women). The average age of the patients was 52 years (ranging from 28 to 82 years). Risk factors of necrotizing fasciitis for our patients were: nonsteroidal anti-inflammatory drugs (82.2%), cutaneous wound (76.4%), obesity (29.4%), oto-rhino-laryngologic diseases (23.5%), alcoholic and drug addicts (23.5%), and diabetis (11.7%). The most isolated and responsible germ was Streptococcus pyogenes in 75.5% of cases. Culture of specimens collected before antibiotic treatment showed that the bacterium was sensible to the antibiotics being administered (clindamycin in 70.5% of cases). The surgical management was early done with an average delay of 2.7 days (ranging from 1 to 15 days). We observed a low mortality rate (11.7%). One patient died during the period of follow-up after one year (average follow-up of 2.0 years; 1-3 years). CONCLUSION: Contrary to the data from the literature, this study presents a decrease of the mortality in necrotizing fasciitis with an early treatment and an adequate management. The precocity and the quality of surgical procedures as well as the presence of an underlying disease are determining factors for successful management of necrotizing fasciitis.

[Keloids: epidemiological aspects and reasons for refusal of surgical treatment in Kinshasa (Democratic Republic of Congo)]. / Chéloïdes: aspects épidémiologiques et raisons du refus du traitement chirurgical à Kinshasa (République Démocratique du Congo).

This population-based cross-sectional study sought to assess the epidemiology of keloids and the reasons for refusal of surgical treatment for them in 24 municipalities of Kinshasa (Democratic Republic of the Congo). The study took 3 months (from March 1 through May 31, 2011) and enrolled 71 patients (43 females and 28 males). The keloids were situated on the ear (21%), chin and neck (20%), thorax (13%), cheek (12%), belly (11%), arm and forearm (6%), shoulder (6%), back (5%), thigh (3%) and leg (3%). The number of keloids per person averaged 1:7 (range: 1-5), that is, approximately 2. Overall, 19% were small (<5 cm longest diameter), 32% intermediate (5-10 cm), and 47% large (> 10 cm). Most patients (79%) did not plan plastic surgery, 44% for financial reasons (lack of money), 18% because they lacked of confidence in the surgery (no favorable prognosis, useless, unreliable), 15% because it would agggravate the lesions, 13% because of fear (dangerous treatment), and 5% because "keloids are a hereditary illness".

Gigantomastie juvenile droite traitee par plastie de reduction mammaire avec un lambeau dermo-glandulaire a pedicule supero-interne : a propos d'un cas

Les auteurs rapportent le cas d'une adolescente de 14 ans presentant une gigantomastie unilaterale droite; chez qui une chirurgie de reduction mammaire; recourant a un lambeau dermo-glandulaire a pedicule supero-interne; a ete realisee par l'Unite de Chirurgie Plastique des Cliniques Universitaires de Kinshasa. Les suites operatoires ont ete simples; avec conservation de la sensibilite et de la coloration de la plaque areolomamelonnaire; de la lactation; ainsi qu'une bonne morphologie du sein reconstruit

[Relapse after surgical treatment of mycobacterium ulcerans infection (buruli ulcer): study of risk factors in 84 patients in the Democratic Republic of the Congo]. / Rechutes après traitement chirurgical exclusif de l'infection à Mycobacterium ulcerans (ulcère de Buruli): étude des facteurs de risque chez 84 patients congolais.

OBJECTIVE: To identify risk factors for relapse after exclusively surgical treatment of Mycobacterium ulcerans infection (Buruli ulcer). METHODS: Study was carried out in 102 patients treated exclusively by surgery for Buruli ulcer at various care facilities in the Congo from January 1, 2000 to January 1, 2005. RESULTS: Outcomes included relapse in 22 patients (21.5%), cure in 62 (60.7%), and unknown in 18 (17.6%). Statistical analysis identified the following variables as independent risk factors for relapse after exclusively surgical treatment: incomplete surgical excision (OR = 91.83; P = 0.0000; IC to 95%), age under 16 years (OR = 14.80; P = 0.0000; IC to 95%) and pre-ulcerative Buruli lesions (edema and plaque) (OR = 3.18; P = 0.0215; IC to 95%). CONCLUSION: Quality of excision, patient age, and clinical form of lesion are the main predictors of relapse after isolated surgical treatment of Buruli ulcer.

[Follow-up of the first case of Mycobacterium ulcerans infection documented by PCR, genotyping and culture in the Republic of Congo-Brazzaville]. / Suivi du premier cas d'infection à Mycobacterium ulcerans confirmé par culture, PCR et génotypage République du Congo-Brazzaville.

This article presents follow-up data from the first patient in whom Mycobacterium ulcerans infection (MUI) was documented by PCR, genotyping and culture in the Republic of Congo-Brazzaville. Findings show the importance of regular clinical and microbiological evaluation for the disseminated form of the disease. The patient was probably infected in Pointe Noire where MUI has been described but never documented. Culture of specimens collected before antibiotic treatment showed that the bacterium was sensitive to the antibiotics being administered (streptomycin and rifampin) and was identical to isolates from Atlantic-coast regions of West Africa where MUI is endemic. The patient was treated with streptomycin and rifampin for 12 weeks in association with surgery. During treatment clinical examination was performed every day and microbiological analysis every two weeks. The duration of follow-up from the end of specific antibiotic treatment was 26 months. Medical treatment failed to prevent bone involvement and fistulae that were treated by surgery. However medical treatment may have limited dissemination of the disease. Serial microbiological evaluation was useful to detect bone involvement in this patient, but persistent positive gene amplification is not a proof of active disease. This study confirms that MUI is still endemic in the region of Pointe Noire. This finding underlines the need to optimize epidemiologic surveillance, laboratory diagnostic capabilities, and therapeutic management in the Republic of Congo-Brazzaville.

[Mycobacterium ulcerans infection treated by Rifater, pyrazynamide, Myambutol, and surgery: a case report with a 6-year follow-up]. / Infection à Mycobacterium ulcerans traitée par Rifater, pyrazynamide, Myambutol associés à la chirurgie : à propos d'un cas avec un recul de six ans.

The author reports a case of pleuritis associated with a large homolateral Buruli thorax ulcer in a nine-year old female patient, in the Democratic Republic of Congo. Smears on Ziehl-Neelsen revealed acid-alcohol-resistant bacilli. The pathological histology confirmed a Mycobacterium ulcerans infection (Buruli ulcer). The treatment was surgical (excision-dressing-grafting) associated to antibiotic therapy (Rifater, Pyrazynamide, and Myambutol). After six years of follow up, no relapse was observed.

[Study of names and folklore associated with Mycobacterium ulcerans infection in various endemic countries in Africa]. / Etude des appellations et des représentations attachées à l'infection à Mycobacterium ulcerans dans différents pays endémiques d'Afrique.

The purpose of this article is to present names used for Mycobacterium ulcerans infection (Buruli ulcer) and explain their meanings in various African languages. Representations associated with the disease were also studied. The study approach involved qualitative analysis of information from interviews and literature. Interviews were conducted with the directors of various programs and management centers. Findings from 9 African countries where Buruli ulcer is known to be endemic, i.e., Benin, Cameroon, Congo-Brazzaville, Côte d'Ivoire, Ghana, Uganda, Democratic Republic of Congo, Southern Sudan and Togo, showed that the names used for the disease could be classified into three categories based on the geographical origin of infection, the features of the observed lesions, and aspects of ost often associated with belief in witch-craft, i.e., bad luck, fetishes, and curses. Representation of the disease in different African languages were similar and appear to demonstrate a good understanding of the disease in the countries where Buruli ulcer is prevalent. The impact of the representations of the disease on therapeutic choices and itineraries is also discussed.

Etude des appellations et des representations attachees a l'infection a Mycobacterium ulcerans dans differents pays endemiques d'Afrique

L'objectif de ce travail est de presenter les appellations de l'infection a Mycobacterium ulcerans (ulcere de Buruli) dans les langues africaines et leurs significations. Il vise egalement a explorer les representations attachees a la maladie dans differents pays endemiques d'Afrique. La methodologie utilisee implique l'analyse d' entretiens indivi- duels et de publications scientifiques. Les entretiens individuels ont ete menes aupres de differents chefs de programme et responsables de structures de prise en charge de cette maladie. Les resultats de notre analyse montrent que dans les pays d'Afrique ou l'ulcere de Buruli est endemique (Benin; Cameroun; Congo-Brazzaville; Cote d'Ivoire; Ghana; Ouganda; Republique Democratique du Congo; Sud Soudan et Togo); les appellations de cette maladie peuvent etre classees en trois categories; suivant qu'elles evoquent les origines geographiques de la maladie; les caracteristiques des lesions observees; ou les aspects d'incurabilite et de mystere; en lien avec la sorcellerie. Les representations de cette maladie dans les langues africaines apparaissent identiques et semblent traduire une connaissance relativement bonne de la maladie dans les pays ou l'ulcere de Buruli sevit. L'impact de ces representations influence egalement les types de recours aux soins

Etude des appellations et des representations attachees a l'infection a mycobacterium ulcerans dans differents pays endemiques d'Afrique

L'objectif de ce travail est de presenter les appellations de l'infection a Mycobacterium ulcerans (ulcere de Buruli) dans les langues africaines et leurs significations. Il vise egalement a explorer les representations attachees a la maladie dans differents pays endemiques d'Afrique. La methodologie utilisee implique l'analyse d'entretiens individuels et de publications scientifiques. Les entretiens individuels ont ete menes aupres de differents chefs de programme et responsables de structures de prise en charge de cette maladie. Les resultats de notre analyse montrent que dans les pays d'Afrique ou l'ulcere de Buruli est endemique (Benin; Cameroun; Congo-Brazzaville; Cote d'Ivoire; Ghana; Ouganda; Republique Democratique du Congo; Sud Soudan et Togo); les appellations de cette maladie peuvent etre classees en trois categories; suivant qu'elles evoquent les origines geographiques de la maladie; les caracteristiques des lesions observees; ou les aspects d'incurabilite et de mystere; en lien avec la sorcellerie. Les representations de cette maladie dans les langues africaines apparaissent identiques et semblent traduire une connaissance relativement bonne de la maladie dans les pays ou l'ulcere de Buruli sevit. L'impact de ces representations influence egalement les types de recours aux soins

[Mycobacterium ulcerans disease (Buruli ulcer): surgical treatment of 102 cases in the Democratic Republic of Congo]. / Ulcère à Mycobacterium ulcerans: prise en charge chirurgicale dans 102 observations en Republique Démocratique du Congo.

This report describes the preliminary results of surgical treatment of 102 patients presenting Buruli ulcer (BU) over the 5-year period from January 1, 2000 to January 1, 2005. The overall purpose is to improve therapeutic management of BU in the Democratic Republic of Congo. The main disease features were the same as those described in the literature. Diffuse mixed ulcerative forms were the most common in the hospital and at the health care center. Infection by Mycobacterium ulcerans was confirmed by microbacteriological analysis and histological study. Surgical removal of the BU was performed with primary suture, protective dressing, or skin grafting. Local care consisted of application of an aqueous solution of chloramine-metronidazole-nitrofurandoine daily after debridement. Skin grafting was performed with or without protective dressing. Preliminary results with a follow-up of 12 months showed healing in 62 cases, recurrece in 22, and unknown outcome in 18. Although surgical treatment was feasible in poor rural facilities, the cost depending on clinical form is high and recurrence is frequent. These findings undersscore the importance of early detection and treatment with antimycobacterials.