[Buruli ulcers in rural areas of Bénin: management of 635 cases]

Over the last six years we have treated 635 cases of Buruli ulcer at the Health and Nutrition Center of Zagnanado located in a rural area of southern Benin. Two thirds of cases involved children or adolescents from damp, swamp-land areas. The large size of this series and the fact that the number of cases increased yearly underlines the epidemic nature of this disease in Benin. Surgery was the only effective treatment and should be performed as early as possible. In our series of 635 cases wide excision of the ulcer and surrounding tissue was performed 797 times and was followed by skin grafting using thin skin grafts in 574 cases. Antibiotic treatment was begun immediately in order to avoid or treat secondary infection which can be severe. Despite the primitive facilities available, in particular the necessity to harvest skin grafts using a plain razor blade, all patients recovered except 5 who died of intercurrent infection. Our experience confirms the efficacy of early treatment of the ulcer by wide excision associated with antibiotic treatment and followed by skin grafting using fine grafts.