THE BURN OF THE HAND, BURN LIKE NO OTHER: STUDY OF 104 CASES IN THE SEQUELAE PHASE.

Burns of the hand are responsible for the aesthetic and functional sequelae that are most often involved, ranging from the simple dyschromia to multiple digits amputation. The Sequelae can be minor requiring medical treatment, or major deserving surgical intervention consisting of a supply of healthy skin, in the form of skin graft or various flaps and plasties. In order to study the epidemiological, clinical, therapeutic and evolutionary characteristics of sequelae in burned hands, we realized a retrospective study in the department of plastic surgery and burns at the Mohammed VI University Hospital in Marrakech, lasting from January 2013 to December 2017. We collected 104 cases including patients who consulted during the phase of sequelae. From this study, we noted the importance of burns in young adults (42%), and children aged less than 6 years (33%) in the context of domestic accidents (76%). We have also noticed the high incidence of burns of the dorsal surface of the hand in adults by butane flames, in the context of a ? Hand-Face syndrome ? and burns of the palmar face in the child by contact. In our study we noted also the frequent association of major sequelae (contracture, pathological scars) and minor sequelae (dyschromia, pruritus, cicatricial fragility, cutaneous hyperesthesia). Sequelae were dominated by fingers and palmar contracture (65.5%). A functional deficit was observed in more than two thirds of cases. Different means of reconstruction were used depending on the location and type of sequelae, local plasties were performed in 84.6% of the cases, excision and skin grafting in 76.9% of the cases, distant flaps in 4.7% of the cases and artificial dermis (Integra?) in one case. The most used local plasties were "Z" plasty (65.5% of cases) and "trident" plasty (26.5% of cases). 78% of grafts used to treat sequelae were a full-thickness skin graft. The interest of an early and well-conducted rehabilitation is unanimously recognized, it has accompanied all phases of treatment in our patients. The evolution was marked by a satisfactory result for most treated patients. The management of burned hands is multidisciplinary; it is a work-requiring cooperation between surgeons, rehabilitators, physiotherapists, occupational therapists and psychologists. The treatment also requires the cooperation of the patient. The motivation of the patient and his entourage is a key factor in the success of this heavy and long-term care. Prevention remains a priority objective.