[Predictive factors of mortality of the burnt persons: study on 221 adults hospitalized between 2004 and 2009]. / Facteurs prédictifs de mortalité des brûlés : étude sur 221 adultes hospitalisés entre 2004 et 2009.

The objective of the present study is the evaluation of the predictive factors of mortality to a troop of Moroccan grown-up serious burnt persons. Variables analyzed in the study are: the age, the sex, the localization of the burn, the degree of burn, indicates Total Body Surface Area (TBSA), indicate Unit of Standard Burn (UBS) and the indication of leases, sepsis and the medical histories (tobacco, diabetes). Factors associated significantly to a mortality raised at the burned patients were the female genital organ, the localization of the burn at the level of the head, the sepsis, one TBSA greater or equal to 20%, an UBS greater or equal to 200 and an indication of leases greater or equal to 75. Other factors such as the age, the degree of burn and the histories did not show a significant difference. An evaluation and a good knowledge of factors associated to a high risk of death allow an adequate coverage of this category of patients.

[Not Available]. / Prise en charge d'un afflux massif de brûles lors d'une situation de catastrophe par incendie au Maroc.

Burn injuries are most commonly encountered during natural disasters or disasters related to human activity (accidental fires in public places, in time of war, or in terrorist attacks). The care and triage of a large number of burn patients is a difficult problem, which requires adequate planning and emergency preparedness in anticipation of such crises. The training and readiness of doctors and paramedics is of utmost importance. The challenges are many: burn treatment requires a large and qualified staff; evacuations should be prioritized according to the severity of the burn and associated injuries; stocks (especially in topical anti-infective and crystalloid) should be sufficient and appropriate; and hospital services in a military training hospital Mohammed V such as there is in Rabat must be able to be quickly adapted to accommodate and isolate these particular patients. The hypothesis of a fire disaster with a mass influx of burn patients at this hospital should leave no room for improvisation, or else the prompt and accurate prognosis of the patients could be severely hindered.

[Rail plastic surgery technique in the treatment of popliteal contractures]. / La plastie en rail dans le traitement des brides rétractiles du creux poplite.

The case is presented of a patient aged 45 years suffering from thermal burns due to flame following the deflagration of a gas cylinder. The initial lesions involved the four limbs, in particular the knee, and the trunk. The initial taking in charge consisted in an early excision-graft of the limbs. The evolution of the burn was marked by the development of hypertrophic scars at the level of the non-transplanted zones and at the edge of the graft as also by the onset of contractures. Because of the functional problem caused by the contracture as a result of the considerably reduced extension, the patient was admitted for surgical treatment. Thanks to the rail technique described, the patient recovered normal knee function. Post-surgical treatment was straightforward with a hospitalization period of one month. The aesthetic results were satisfactory. The rail technique is part of the therapeutic arsenal for treating knee contractures. Its simplicity, easy technique, and satisfactory results, plus its easy follow-up, make it a highly appreciated technique in the treatment of this type of contracture.

Epidemiological analysis of burn patients in the military hospital, Rabat, Morocco.

A retrospective study was conducted of burn patients admitted to the military hospital in Rabat, Morocco, in the 6-yr period from 2004 to 2009. This is the first multivariate study to be performed in Morocco. The epidemiological data from the 291 patients hospitalized were collected and studied. The type of burn was indicated in 284 of the patients: 94% of the injuries were thermal burns, 4% were electrical burns, and 1.5% chemical burns. In 261 cases the exact aetiology was noted: 56% of accidents were caused by flames, 38% by hot liquids, 4% by electric current, and 2% by chemicals. The distribution of the Moroccan population is as follows: 0-4 yr, 7%; 5-l4 yr, 8%; 15-19 yr, 8%; 20-59 yr, 70%; over 60 yr, 7%. The male/female sex ratio was 1.63. The mean duration of hospitalization stay was 42 ± 62 days. The mean body surface area burned was 21 ± 18%. Total mortality was 5%; 57% of deaths were due to septic shock. Our results were similar to data from other studies in the literature, with certain characteristics in our series, especially the age bracket most affected, the body surface area burned, and the mechanisms of injury.

[The Ogilvie syndrome in a severely burned patient]. / Le syndrome d'ogilvie chez le brule grave.

The Ogilvie syndrome is an acute colonic dilatation of the previously healthy colon, without any organic obstruction. Pathological circumstances such as burns and antipsychotic medication have been identified as predisposing elements. The incidence of this complication, in the reanimation of burn patients, varies between 0.5 to 1%. The purpose of our study is to draw attention to the Ogilvie symptom by describing a case with its clinical and paraclinical data, its physiopathological causes, and the therapeutic aspects. The clinical picture in our patient was characteristic: extensive abdominal meteorism. The abdominal scan showed massive colonic dilatation without any mechanical obstacles. The outcome was successful after colonoscopic exsufflation. The Ogilvie syndrome is a rare occurrence which without effective treatment may result in caecal perforation and a poor prognosis. It is therefore necessary to establish the diagnosis early and, in particular, to initiate close radiological follow-up after the establishment of medical treatment, in which colonoscopy plays an important part.

[Tissue expanders in the treatment of burn injuries]. / Les Protheses d'Expansion dans le Traitement des Sequelles de Brulures.

Les Auteurs présentent leur protocole pour l'expansion cutanée et rapportent quatre cas colligés au service des brûlures de leur hôpital au Maroc. Ils décrivent leur technique opératoire et les résultats obtenus. L'expansion cutanée reste la méthode de choix pour la couverture des pertes de substance étendues et la correction des séquelles de brûlure, et l'expérience rapportée par les Auteurs confirme les bons résultats que l'on peut obtenir avec cette technique, y compris les résultats esthétiques.

[Burns and pregnancy: report on two cases and review of the literature]. / Brulure et Grossesse: A Propos de Deux Cas et Revue de la Litterature.

Les brûlures thermiques au cours de la grossesse sont rares, cependant elles requièrent une attention particulière du fait qu'elles engagent le pronostic maternel et foetal. Les Auteurs rapportent deux observations qui illustrent la gravité de cette association. Le traitement des brûlures pendant la grossesse connaît des particularités en rapport avec les modifications anatomiques et physiologiques de la gestation. Certains Auteurs ont préconisé des recommandations, comme en particulier le traitement précoce de la thrombose veineuse et la surveillance obstétricale avec un accouchement dirigé à l'approche du terme. La mortalité maternelle et périnatale augmente significativement à partir de 50% de la surface corporelle brûlée. De ce fait une prise en charge multidisciplinaire est indispensable. Le pronostic de brûlure chez la femme enceinte reste très réservé, d'où l'intérêt d'une prise en charge multidisciplinaire réunissant obstétricien, réanimateur et plasticien.

[Role of the aponeurotic variation of the posterior interosseous flap in the treatment of burns sequelae on the dorsum of the hand]. / Place du Lambeau Interosseux Posterieur dans sa Variante Aponevrotique dans le Traitement des Sequelles de Brulure de la Face Dorsale de la Main.

Le lambeau interosseux postérieur dans sa variante aponévrotique est un outil très intéressant dans le traitement des séquelles de brûlures de la face dorsale de la main. Les Auteurs cherchent, à travers un cas clinique et une revue de la littérature, à replacer cette variante dans l'arsenal thérapeutique.

[Chemical burns caused by the shrub nerium oleander]. / Les Brulures Chimiques Par Le Laurier Rose.

Nerium Oleander is a shrub that grows naturally in the Mediterranean regions. In Morocco it is found in wet places. It is famous for its risk of systemic toxicity in cases of poisoning because of the presence of two alkaloids, especially oleandrine. The literature describes cases of local use of leaves of this plant against scabies, haemorrhoids, and boils. We report two cases of chemical burns of different gravity due to Nerium Oleander. This should lead to more widely diffused information for the general population and strict regulation of its marketing.

[Utility of the hypogastric flap in the treatment of burns to the dorsum of the hand]. / Interet du Lambeau Hypogastrique Dans le Traitement des Sequelles de Brulure de la Face Dorsale de la Main.

Hypogastric flaps are axial cutaneous flaps vascularized by the superficial inferior epigastric pedicle. They are an effective way of covering the posterior face of the hand and wrist. Four patients benefited from this manner of substance loss after excision of the scar tissue required a hypogastric flap severed on day 21. The aesthetical and functional results were quite satisfactory. This type of flap is the technique of choice in the treatment of hand burn sequelae with exposure of the noble elements - with its ease of dissection, it presents few complications and requires only a little eventual touching-up to provide optimal results.

[Burns by electric scalpel blade: four cases]. / Brulure par Plaque de Bistouri Electrique: a Propos de Quatre Cas.

A burn due to the plate of a diathermy knife is a rare but serious accident owing to the depth of the lesion and its localization, especially when it occurs in a surgical context that creates difficulties for both the patient and the surgeon. Such burns are unpredictable and also serious not only because of their location but also because they occur during a surgical operation in patients who are already ill. Such burns have to be dealt with by specialists. Prevention is the only way of avoiding this kind of accident.

[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.

[Not Available]. / La Prise en Charge des Brulures Electriques: a Propos de 30 Cas.

Les brûlures électriques sont rares mais graves nécessitant une prise en charge urgente et adéquate car l'évolution peut être émaillée de complications graves, notamment cardiaques, neurologiques et rénales, et les séquelles sont importantes. A travers une étude analytique et rétrospective de janvier 2000 à novembre 2007 ayant inclus 30 patients admis au Service des Brûlés de l'Hôpital Militaire d'Instruction Mohamed V de Rabat, Maroc, pour prise en charge de brûlures électriques, il a été relaté les mécanismes des brûlures électriques, comme aussi les complications, la morbidité et la mortalité, dues aux brûlures électriques, tout en insistant sur les modalités de prise en charge initiale chez ces patients. La prévention reste le point capital pour réduire l'incidence de ces accidents. Cette prévention se base sur la surveillance des enfants et l'élimination de facteurs de risque à la maison, par la maintenance des installations électriques et par l'information et l'éducation du public.

[Not Available]. / Brulures par Bouillottes Chez les Diabetiques.

Diabetic neuropathy is a frequent complication of diabetes. The most frequent clinical form is known as "sock polyneuritis", with loss of sensitivity to pain in the feet. Hot water bottle burns are the prerogative of diabetic patients suffering from a form of sensitive polyneuropathy. Such burns are deep. It is difficult to take therapeutic responsibility and decisions must be multidisciplinary. We underline the importance of the education of diabetic patients and of arousing their awareness to the possible risks involved in the use of hot water bottles.

[Not Available]. / Prise en Charge du Syndrome de Lyell ou Necrolyse Epidermique Toxique.

Le syndrome de Lyell ou nécrolyse épidermique toxique (NET) est une pathologie très grave des dermatoses bulleuses d'étiologie médicamenteuse. Il se caractérise par une nécrose aiguë de l'épiderme sur toute la hauteur du corps muqueux. L'aspect clinique de la NET est celui d'une brûlure étendue du deuxième degré profond. A ce tableau s'associent constamment des lésions muqueuses et une atteinte multiviscérale qui aggrave le pronostic. Nous rapportons deux cas de NET qui illustrent l'importance d'une prise en charge précoce et multidisciplinaire de ces patients atteints au sein d'un service de réanimation des brûlés, dont les fondements reposent sur l'asepsie rigoureuse, l'apport hydroélectrolytique et nutritionnel, la prévention de l'infection et son traitement par une antibiothérapie adaptée, et un nursing et des soins locaux. L'efficacité supposée des immunoglobulines intraveineuses ne repose que sur des cas isolés et il n'y a pas encore d'études randomisées.

[Squamous Cell Carcinoma on burn scar: Summary of five cases]. / Epithelioma Spinocellulaire sur Cicatrice de Brulure (a Propos de Cinq Cas).

In order to study Marjolin's ulcer, all the case histories of patients admitted over a 5-yr period to a Service of Plastic Surgery and Burn Patients in Morocco presenting a histopathologically confirmed burn scar cancer were included in a data file with information regarding the medical background of the five patients concerned, their treatment, and the evolution of the case.After this data presentation, the problems set by spinocellular epithelioma, which is a serious and rare affection, are considered.The degeneration of burn scars is a dramatic development, caused by negligence. Preventive treatment, with systematic exeresis of any suspicious lesion, is strongly recommended as it guarantees almost certain recovery.

[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.

[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.