VERNEUILS DISEASE

Verneuil's disease is a chronic fistulating, sclerosing and scar-forming suppuration. Its diagnosis is often misunderstood and therefore mistaken for another pathology. Through the analysis of 13 observations of Verneuil's disease, we wanted to take stock of the clinical diagnosis, the ethiopathogenesis and the therapeutic principles of this disease. Descriptive retrospective study including all hospitalized patients in the plastic surgery department of CHU Mohammed VI in Marrakech Morocco for a Verneuil?s disease, from January 2009 to December 2015. The characteristics of the disease and the therapeutic proposal were analyzed and the effectiveness and satisfaction of the surgical treatment evaluated. In 6 years, 13 patients (10 men and 3 women) with an average age of 43.8 years were hospitalized in our department. Smoking was present in six of our patients ie 46% of our active smoking-type patients with an average of 31.1 years packs. The mean age of onset of the disease for women was 24.2 years and 30.6 years for men. The average diagnosis time for the disease was 9.32 years with extremes of 2 months and 43 years, the diagnosis was carried by a dermatologist in the majority of cases. The average body mass index value of patients in our series is 25.78 kg / m2 with extreme values of 20.2 and 31.1 kg / m?, which corresponds to an overweight. The most common localization is axillary localization followed by gluteal localization. Hurley's score varied between 3 grades with a predominance of grade 3 for the 34 territories reached for our 13 patients. Two of our patients had ulcerated-budding lesions with irregular edges on scar placards, in whom the cutaneous biopsy demonstrated a squamous cell carcinoma. Eleven patients had a total lesion excision, unlike partial excision, which has never been performed for any of these patients. Two patients underwent carcinological tumor excision with lymph node dissection for squamous cell carcinoma. The type of cover that has been most used in this series is the direct suture. Skin transplantation by thin skin was performed for 7 territories in 6 patients with a delay of 3.5 months, with extreme values of 2 and 6 months. The territories where the skin graft was carried out are the gluteus territory to the number of 4 and the axillary territory to the number of 3. The directed healing was carried out for the two patients who benefited from a carcinological excision. The complications found in our patients 1 cases of haemorrhage, 1 case of perioperative recurrence, 1 case of sequellar bridle, 2 cases of hypertrophic scar, 2 cases of persistent pain. The satisfaction of the surgical treatment could be evaluated in postoperative with a follow-up of more than 9 months in 7 patients who are satisfied with the surgical treatment. At a time, when new molecules have been developed and studied for the treatment of Verneuil's disease, surgical excision remains a treatment of choice in some situations. Medico-surgical discussion is essential for the management of this disease and its development must be a priority.