SEQUELAE OF HAND BURN: EPIDEMIOLOGICAL AND THERAPEUTIC ASPECTS IN MOROCCAN STUDY

Hand burns can result in both aesthetic and functional sequelae, which are often intertwined, ranging from simple dyschromia to multidigital amputation. They can be minor, requiring medical treatment, or major, requiring surgical treatment consisting of skin grafting or various flaps and plasties. To study the epidemiological, clinical, therapeutic, and evolutionary characteristics of burned hand sequelae, we conducted a retrospective study at the Plastic and Burn Surgery Department of the Mohammed VI University Hospital Center in Marrakech, from January 2013 to December 2017. The study collected 104 cases, including patients with burn sequelae in at least one hand. This work shows that almost one in two patients hospitalized for burns has a burn on at least one hand. The study also shows the frequency of young adult injuries (42%) and children under six years old (33%) in domestic accidents (76%), the frequency of burns to the dorsal surface of the hands from butane flames in the Hand-Face Syndrome in adults, and the frequency of burns to the palmar surface in children. Concerning the sequelae phase, our study shows the frequent association of major sequelae (contractures, retraction, pathological scars) and minor sequelae (dyschromia, itching, scar fragility, cutaneous hyperesthesia). The sequelae were dominated by digital and digito-palmar retractions (65.5%). A functional deficit was observed in more than two-thirds of cases. Various means of reconstruction were used depending on the location and type of sequelae local plasties were performed in 84.6% of cases, and excision-grafts in 76.9% of cases. The most commonly used local plasties were the Z plastie (65.5% of cases) and the trident plasty (26.5% of cases). 78% of the grafts used to treat sequelae were full-thickness skin grafts. The evolution was marked by a satisfactory result for most treated patients. The management of burned hands is multidisciplinary, requiring cooperation between surgeons, physicians, rehabilitators, physiotherapists, and psychologists.