A Moroccan plastic surgery department approach during COVID-19 pandemic.

COVID-19 pandemic is an obstacle for all health systems, especially in African countries. This paper shows how plastic surgery teams can adapt human resources and an efficient approach to provide the best care to our patients in this troubled time.

[Not Available]. / Brûlure chez l'épileptique: brûlure pas comme les autres.

The association of burns and epilepsy is frequent in Morocco. These burns, often recurring, mainly occur in young women living in rural areas. The accidents usually occur in the kitchen and involve falling onto stoves situated on the floor during an epileptic crisis. Such burns may occur during a first attack before epilepsy has been diagnosed although, more often than not, the patient's illness is already known but insufficiently treated and managed. Consequences of these burns, which are always deep, are often tragic considering the sequelae, in patients whose social reintegration is already marred by epilepsy. Treatment should focus on both burns and epilepsy. Preventive measures to keep the epilepsy in check and avoid these sufferers being left alone in proximity to heat sources should be put in place.

[Not Available]. / La greffe de peau totale dans le traitement des séquelles de brûlures de la main et des doigts: A propos de 84 cas.

We conducted a retrospective study of data from September 2004 to September 2012, involving roughly 84 patients with burn sequelae of the hand who were treated surgically with full thickness skin grafts. The purpose of our study was to show the simplicity, effectiveness and reliability of this surgical technique. The average age at which the burn occurred was 4 years old. The average age of our patients was 18,3 years old (range=2-62 years old); males were affected in 60% of cases. The most frequent cause of injury were thermal burns, most often caused by hot liquids (56%). The mean delay between the burn having healed and the management of the sequelae to the hand was 36 months (2 months-16 years). The lesions were localized in the palm of the hand in 69 cases (82,5%). The sequelae were dominated by finger contractures (65%). A functional deficit was noted in the physical examination of all our patients. Full thickness skin grafts were applied in all our patients following release of the contractures and excision of the scar tissue. Commissural contractures were treated with Z-plasties. In 95% of the cases, the full thickness skin grafts were taken from the inguinal crease. The mean follow-up was 5,5 years (1-8 years). Eleven patients went missing from the study. The results after healing and rehabilitation were deemed to be satisfactory (good) in 62 cases (85%) and fairly satisfactory (quite good) in 11 cases (15%). Well-conducted initial treatment, carried out under the best conditions, can not only reduce the number of burn sequelae but also make them less severe.

[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.

[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.