Videos of Surgical Procedures in Dermatology
Combined Cutaneous Rotation Flap and Myomucosal Tongue Flap for Reconstruction of an Upper Lip Defect
Combinación de colgajo cutáneo de rotación con colgajo mio-mucoso de lengua para la reconstrucción de defecto del labio superior
Leído
6293
Vecesse ha leído el artículo
2115
Total PDF
4178
Total HTML
Compartir estadísticas
array:24 [ "pii" => "S000173101400101X" "issn" => "00017310" "doi" => "10.1016/j.ad.2014.01.009" "estado" => "S300" "fechaPublicacion" => "2014-11-01" "aid" => "982" "copyright" => "Elsevier España, S.L. and AEDV" "copyrightAnyo" => "2013" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2014;105:869-71" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1299 "formatos" => array:3 [ "EPUB" => 48 "HTML" => 893 "PDF" => 358 ] ] "Traduccion" => array:1 [ "en" => array:18 [ "pii" => "S157821901400273X" "issn" => "15782190" "doi" => "10.1016/j.adengl.2014.09.017" "estado" => "S300" "fechaPublicacion" => "2014-11-01" "aid" => "982" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2014;105:869-71" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1602 "formatos" => array:3 [ "EPUB" => 45 "HTML" => 1145 "PDF" => 412 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Videos of Surgical Procedures in Dermatology</span>" "titulo" => "Combined Cutaneous Rotation Flap and Myomucosal Tongue Flap for Reconstruction of an Upper Lip Defect" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "869" "paginaFinal" => "871" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Combinación de colgajo cutáneo de rotación con colgajo mio-mucoso de lengua para la reconstrucción de defecto del labio superior" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 798 "Ancho" => 950 "Tamanyo" => 178687 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Result 9 months after surgery.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A.F. Massa, M. Otero-Rivas, B. González-Sixto, M.Á. Rodríguez-Prieto" "autores" => array:4 [ 0 => array:2 [ "nombre" => "A.F." "apellidos" => "Massa" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Otero-Rivas" ] 2 => array:2 [ "nombre" => "B." "apellidos" => "González-Sixto" ] 3 => array:2 [ "nombre" => "M.Á." "apellidos" => "Rodríguez-Prieto" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S000173101400101X" "doi" => "10.1016/j.ad.2014.01.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S000173101400101X?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157821901400273X?idApp=UINPBA000044" "url" => "/15782190/0000010500000009/v1_201410280115/S157821901400273X/v1_201410280115/en/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S000173101400180X" "issn" => "00017310" "doi" => "10.1016/j.ad.2013.12.022" "estado" => "S300" "fechaPublicacion" => "2014-11-01" "aid" => "989" "copyright" => "Elsevier España, S.L.U. y AEDV" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2014;105:872-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1262 "formatos" => array:3 [ "EPUB" => 2 "HTML" => 853 "PDF" => 407 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Dermatoscopia práctica</span>" "titulo" => "¡Ojo con los tumores rojos!" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "872" "paginaFinal" => "873" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Beware of Red Tumors!" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 518 "Ancho" => 1400 "Tamanyo" => 113244 ] ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "P. Zaballos Diego" "autores" => array:1 [ 0 => array:2 [ "nombre" => "P." "apellidos" => "Zaballos Diego" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219014002534" "doi" => "10.1016/j.adengl.2014.09.013" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219014002534?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S000173101400180X?idApp=UINPBA000044" "url" => "/00017310/0000010500000009/v1_201410280121/S000173101400180X/v1_201410280121/es/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S000173101400177X" "issn" => "00017310" "doi" => "10.1016/j.ad.2014.03.002" "estado" => "S300" "fechaPublicacion" => "2014-11-01" "aid" => "986" "copyright" => "Elsevier España, S.L.U. y AEDV" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2014;105:867-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3608 "formatos" => array:3 [ "EPUB" => 2 "HTML" => 1449 "PDF" => 2157 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Casos para el diagnóstico</span>" "titulo" => "Mácula hiperpigmentada extensa en la pierna de una mujer adolescente" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "867" "paginaFinal" => "868" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Large Hyperpigmented Macule on the Leg of an Adolescent Girl" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1333 "Ancho" => 889 "Tamanyo" => 151025 ] ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Calderón-Komáromy, A. Romero-Maté, A. Moreno" "autores" => array:3 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Calderón-Komáromy" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Romero-Maté" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Moreno" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219014002522" "doi" => "10.1016/j.adengl.2014.09.012" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219014002522?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S000173101400177X?idApp=UINPBA000044" "url" => "/00017310/0000010500000009/v1_201410280121/S000173101400177X/v1_201410280121/es/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Videos of Surgical Procedures in Dermatology</span>" "titulo" => "Combined Cutaneous Rotation Flap and Myomucosal Tongue Flap for Reconstruction of an Upper Lip Defect" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "869" "paginaFinal" => "871" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A.F. Massa, M. Otero-Rivas, B. González-Sixto, M.Á. Rodríguez-Prieto" "autores" => array:4 [ 0 => array:4 [ "nombre" => "A.F." "apellidos" => "Massa" "email" => array:1 [ 0 => "antoniofmassa@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M." "apellidos" => "Otero-Rivas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "B." "apellidos" => "González-Sixto" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "M.Á." "apellidos" => "Rodríguez-Prieto" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Dermatology Department, Centro Hospitalar de V.N.Gaia/Espinho, EPE, Vila Nova de Gaia, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Dermatology Department, Complejo Asistencial Universitario de León, Léon, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Combinación de colgajo cutáneo de rotación con colgajo mio-mucoso de lengua para la reconstrucción de defecto del labio superior" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1330 "Ancho" => 1583 "Tamanyo" => 378968 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Result 9 months after surgery.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The upper lip is a rare site for nonmelanoma skin cancer. This lip suffers considerably less actinic damage than the lower lip, and reports of upper lip reconstruction are therefore scarce.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Lip reconstruction is a challenge to the dermatological surgeon, particularly when there are full-thickness defects. Adequate opening of the oral orifice must be ensured, without altering sphincter function, and good symmetry of the mouth with correct apposition of the vermilion must be achieved.</p><p id="par0015" class="elsevierStylePara elsevierViewall">We report the case of a white man aged 70 years who presented a recurrent squamous cell carcinoma of the upper lip with an adjacent basal cell carcinoma. Three stages of Mohs micrographic surgery were required to remove the lesions, leaving a full-thickness defect of 3.5<span class="elsevierStyleHsp" style=""></span>cm×2<span class="elsevierStyleHsp" style=""></span>cm affecting the left lateral subunit of the upper lip, with a minimal defect at the commissure (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Procedure</span><p id="par0020" class="elsevierStylePara elsevierViewall">Reconstruction was performed in two stages.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">First Operation</span><p id="par0025" class="elsevierStylePara elsevierViewall">For the first stage of the repair, performed under local anesthesia, we designed a cutaneous rotation flap with a lateral pedicle on the left half lip, undermining at the level of the muscle plane.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> This flap was then positioned in the skin defect of the lip, reaching the vermilion border (Klein's line). The subcutaneous tissue plane was sutured with absorbable 4/0 polyglycolic acid sutures and the skin with 4/0 silk. A new commissure was fashioned by direct closure of the small mucosal defect.</p><p id="par0030" class="elsevierStylePara elsevierViewall">We then designed an ipsilateral tongue flap of approximately the same width as the remaining defect. This flap was undermined in the muscle plane to provide a myomucosal flap to replace not only the vermilion of the upper lip but also the resected part of the orbicularis oris muscle. Flap dissection had to be continued 1<span class="elsevierStyleHsp" style=""></span>cm beyond the lateral border of the tongue to facilitate advancement of the flap into the defect. The lateral mucosal tongue flap, still attached to the tongue at its inferior border, was sutured to the cutaneous lip flap with 4/0 silk (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), and the tongue was fixed to the upper right half lip with 2/0 silk.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">After the operation, the patient was given enteral nutritional support and antibiotic prophylaxis, as well as a short course of corticosteroid therapy to prevent excessive inflammation.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Second Operation</span><p id="par0040" class="elsevierStylePara elsevierViewall">Two weeks after the first operation we divided the bridge between the myomucosal flap and the tongue. The flap was then adjusted and its inferior border was sutured to the posterior border of the lip defect with absorbable 4/0 polyglycolic acid suture. Direct closure of the tongue defect was then performed with 4/0 polyglycolic acid suture.</p><p id="par0045" class="elsevierStylePara elsevierViewall">This 2-flap technique, used after 3 stages of Mohs micrographic surgery, is presented in the accompanying video.</p><p id="par0050" class="elsevierStylePara elsevierViewall">There was no evidence of alterations of taste, speech, or swallowing, and sphincter function of the orbicularis oris muscle was preserved. The cosmetic result was excellent (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Indications</span><p id="par0055" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">•</span><p id="par0060" class="elsevierStylePara elsevierViewall">Full-thickness defects of the lip with a minor skin defect.</p></li></ul></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Contraindications</span><p id="par0065" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">•</span><p id="par0070" class="elsevierStylePara elsevierViewall">This technique is unsuitable for patients of advanced age or those with a poor nutritional status, as prolonged nutritional support and a second operation are required.</p></li></ul></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Complications</span><p id="par0075" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">•</span><p id="par0080" class="elsevierStylePara elsevierViewall">Infection, inflammation and wasting due to the need for a second operation.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">•</span><p id="par0085" class="elsevierStylePara elsevierViewall">Enteral nutrition is mandatory, and follow-up by an endocrinologist is therefore recommended.</p></li></ul></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Discussion</span><p id="par0090" class="elsevierStylePara elsevierViewall">The lower lip is considered a single subunit, but the upper lip is divided into 2 lateral subunits and the philtrum. Following the classic principles of facial subunit reconstruction, each subunit should be reconstructed as a whole,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> except for small defects in which direct closure is a reasonable option.</p><p id="par0095" class="elsevierStylePara elsevierViewall">In the lip, it is essential to maintain the border between the vermilion and the normal skin (Klein's line), as any alteration would produce a noticeable cosmetic defect. The commissures need to be correctly positioned to avoid microstomia and inadequate mouth opening.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">The appropriate repair procedure for full-thickness defects depends mainly on the lip volume involved. Various techniques, such as Abbe, Estlander, Gilles, and Webster flaps, have been proposed to reconstruct full-thickness defects, but these involve the full height of the lip.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In our opinion, excision of the full height and width of the ipsilateral cutaneous lip or the lower lip to reconstruct the defect of the upper lip in our patient did not seem reasonable.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">In our patient, the defect comprised skin, muscle, and mucosa, and all 3 layers must be reconstructed to achieve a good functional and cosmetic result. We decided to perform a combination of flaps as the defects of the muscle and mucosa were much larger than the skin defect. The cutaneous rotation flap provided skin for the cutaneous part of the lip defect and two of the scars were hidden in natural skin folds.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Tongue flaps have been employed for reconstruction of the vermilion of the upper and lower lips. These provide sufficient muscle to maintain sphincter function of the orbicularis oris muscle, and the mucosa will provide tissue of similar characteristics to the vermilion, giving a good functional result without microstomia. The main disadvantage of tongue flaps is the need for a 2-week period of hospitalization with nutritional support.</p><p id="par0115" class="elsevierStylePara elsevierViewall">The use of a combined tongue flap and cutaneous rotation flap in this case achieved an excellent functional and cosmetic result.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conflict of Interest</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 1 => array:3 [ "identificador" => "sec0010" "titulo" => "Procedure" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "First Operation" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Second Operation" ] ] ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Indications" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Contraindications" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Complications" ] 5 => array:2 [ "identificador" => "sec0040" "titulo" => "Discussion" ] 6 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflict of Interest" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0130" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0055" ] ] ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1178 "Ancho" => 1583 "Tamanyo" => 416137 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Defect of 3.5<span class="elsevierStyleHsp" style=""></span>cm×2<span class="elsevierStyleHsp" style=""></span>cm after 3 stages of Mohs micrographic surgery to the left upper lip. There is a large defect of the muscle and mucosa and a small skin defect.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1071 "Ancho" => 1583 "Tamanyo" => 414769 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">First stage of reconstruction. A cutaneous rotation flap with a lateral pedicle was fashioned from the left half lip, and the vermilion border (Klein's line) was recreated by suturing the lateral tongue flap to the skin flap.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1330 "Ancho" => 1583 "Tamanyo" => 378968 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Result 9 months after surgery.</p>" ] ] 3 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc1.mp4" "ficheroTamanyo" => 52017237 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc1.flv" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:2 [ "fichero" => "mmc1.m4v" "poster" => "mmc1.jpg" ] ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgical planes of the head and neck" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E. Samaniego" 1 => "C. Prada" 2 => "M.A. Rodríguez-Prieto" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ad.2010.07.005" "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2011" "volumen" => "102" "paginaInicial" => "167" "paginaFinal" => "174" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21353190" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Aesthetic restoration of one-half the upper lip" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G.C. Burget" 1 => "F.J. Menick" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Plast Reconstr Surg" "fecha" => "1986" "volumen" => "78" "paginaInicial" => "583" "paginaFinal" => "593" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3763745" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgical repair of labial defect" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "O. Malard" 1 => "P. Corre" 2 => "F. Jégoux" 3 => "N. Durand" 4 => "B. Dréno" 5 => "C. Beauvillain" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.anorl.2010.04.001" "Revista" => array:6 [ "tituloSerie" => "Eur Ann Otorhinolaryngol Head Neck Dis" "fecha" => "2010" "volumen" => "127" "paginaInicial" => "49" "paginaFinal" => "62" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20822758" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A regional approach to reconstruction of the upper lip" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "W.Y. Yih" 1 => "D.W. Howerton" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Oral Maxillofacial Surg" "fecha" => "1997" "volumen" => "55" "paginaInicial" => "383" "paginaFinal" => "389" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Split myomucosal advancement flap for reconstruction of a lower lip defect" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C.J. Glenn" 1 => "R.T. Adelson" 2 => "F.P. Flowers" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1524-4725.2012.02392.x" "Revista" => array:6 [ "tituloSerie" => "Dermatol Surg" "fecha" => "2012" "volumen" => "38" "paginaInicial" => "1725" "paginaFinal" => "1728" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22471340" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nasolabial rotation flaps based on the upper lateral lip subunit for superficial and large defects of the upper lateral lip" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G.C. Burget" 1 => "Y.C. Hsiao" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/PRS.0b013e31825dc09f" "Revista" => array:6 [ "tituloSerie" => "Plast Reconstr Surg." "fecha" => "2012" "volumen" => "130" "paginaInicial" => "556" "paginaFinal" => "560" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22929240" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/00017310/0000010500000009/v1_201410280121/S000173101400101X/v1_201410280121/en/main.assets" "Apartado" => array:4 [ "identificador" => "6159" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Videos de cirugía dermatológica" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/00017310/0000010500000009/v1_201410280121/S000173101400101X/v1_201410280121/en/main.pdf?idApp=UINPBA000044&text.app=https://www.actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S000173101400101X?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Octubre | 45 | 34 | 79 |
| 2024 Septiembre | 71 | 26 | 97 |
| 2024 Agosto | 91 | 40 | 131 |
| 2024 Julio | 71 | 23 | 94 |
| 2024 Junio | 80 | 31 | 111 |
| 2024 Mayo | 60 | 29 | 89 |
| 2024 Abril | 76 | 29 | 105 |
| 2024 Marzo | 56 | 33 | 89 |
| 2024 Febrero | 59 | 34 | 93 |
| 2024 Enero | 55 | 31 | 86 |
| 2023 Diciembre | 63 | 16 | 79 |
| 2023 Noviembre | 65 | 30 | 95 |
| 2023 Octubre | 68 | 22 | 90 |
| 2023 Septiembre | 70 | 29 | 99 |
| 2023 Agosto | 60 | 21 | 81 |
| 2023 Julio | 94 | 52 | 146 |
| 2023 Junio | 46 | 31 | 77 |
| 2023 Mayo | 71 | 35 | 106 |
| 2023 Abril | 52 | 17 | 69 |
| 2023 Marzo | 70 | 23 | 93 |
| 2023 Febrero | 59 | 22 | 81 |
| 2023 Enero | 46 | 29 | 75 |
| 2022 Diciembre | 52 | 36 | 88 |
| 2022 Noviembre | 57 | 40 | 97 |
| 2022 Octubre | 73 | 40 | 113 |
| 2022 Septiembre | 59 | 51 | 110 |
| 2022 Agosto | 75 | 48 | 123 |
| 2022 Julio | 43 | 40 | 83 |
| 2022 Junio | 48 | 36 | 84 |
| 2022 Mayo | 64 | 36 | 100 |
| 2022 Abril | 62 | 28 | 90 |
| 2022 Marzo | 69 | 52 | 121 |
| 2022 Febrero | 59 | 24 | 83 |
| 2022 Enero | 63 | 46 | 109 |
| 2021 Diciembre | 50 | 31 | 81 |
| 2021 Noviembre | 60 | 46 | 106 |
| 2021 Octubre | 78 | 68 | 146 |
| 2021 Septiembre | 53 | 36 | 89 |
| 2021 Agosto | 45 | 28 | 73 |
| 2021 Julio | 36 | 35 | 71 |
| 2021 Junio | 49 | 35 | 84 |
| 2021 Mayo | 39 | 31 | 70 |
| 2021 Abril | 107 | 82 | 189 |
| 2021 Marzo | 82 | 24 | 106 |
| 2021 Febrero | 60 | 24 | 84 |
| 2021 Enero | 36 | 17 | 53 |
| 2020 Diciembre | 52 | 15 | 67 |
| 2020 Noviembre | 30 | 31 | 61 |
| 2020 Octubre | 34 | 22 | 56 |
| 2020 Septiembre | 65 | 18 | 83 |
| 2020 Agosto | 52 | 18 | 70 |
| 2020 Julio | 56 | 15 | 71 |
| 2020 Junio | 49 | 11 | 60 |
| 2020 Mayo | 33 | 13 | 46 |
| 2020 Abril | 36 | 25 | 61 |
| 2020 Marzo | 31 | 18 | 49 |
| 2020 Febrero | 2 | 0 | 2 |
| 2020 Enero | 6 | 2 | 8 |
| 2019 Diciembre | 8 | 2 | 10 |
| 2019 Noviembre | 4 | 1 | 5 |
| 2019 Octubre | 1 | 1 | 2 |
| 2019 Septiembre | 5 | 0 | 5 |
| 2019 Agosto | 4 | 7 | 11 |
| 2019 Julio | 5 | 7 | 12 |
| 2019 Junio | 5 | 9 | 14 |
| 2019 Mayo | 7 | 15 | 22 |
| 2019 Abril | 4 | 2 | 6 |
| 2019 Marzo | 5 | 10 | 15 |
| 2019 Febrero | 5 | 1 | 6 |
| 2019 Enero | 11 | 3 | 14 |
| 2018 Diciembre | 2 | 4 | 6 |
| 2018 Noviembre | 6 | 0 | 6 |
| 2018 Octubre | 5 | 2 | 7 |
| 2018 Septiembre | 2 | 0 | 2 |
| 2018 Junio | 0 | 4 | 4 |
| 2018 Mayo | 0 | 11 | 11 |
| 2018 Marzo | 0 | 3 | 3 |
| 2018 Febrero | 28 | 3 | 31 |
| 2018 Enero | 26 | 4 | 30 |
| 2017 Diciembre | 43 | 7 | 50 |
| 2017 Noviembre | 21 | 13 | 34 |
| 2017 Octubre | 21 | 6 | 27 |
| 2017 Septiembre | 22 | 13 | 35 |
| 2017 Agosto | 25 | 14 | 39 |
| 2017 Julio | 33 | 9 | 42 |
| 2017 Junio | 32 | 59 | 91 |
| 2017 Mayo | 25 | 12 | 37 |
| 2017 Abril | 29 | 9 | 38 |
| 2017 Marzo | 20 | 24 | 44 |
| 2017 Febrero | 13 | 6 | 19 |
| 2017 Enero | 11 | 7 | 18 |
| 2016 Diciembre | 36 | 11 | 47 |
| 2016 Noviembre | 29 | 13 | 42 |
| 2016 Octubre | 12 | 16 | 28 |
| 2016 Septiembre | 0 | 11 | 11 |
| 2016 Agosto | 1 | 1 | 2 |
| 2016 Julio | 7 | 1 | 8 |
| 2016 Junio | 18 | 5 | 23 |
| 2016 Mayo | 8 | 2 | 10 |
| 2016 Abril | 7 | 6 | 13 |
| 2016 Marzo | 12 | 3 | 15 |
| 2016 Febrero | 13 | 2 | 15 |
| 2016 Enero | 16 | 1 | 17 |
| 2015 Diciembre | 14 | 0 | 14 |
| 2015 Noviembre | 13 | 1 | 14 |
| 2015 Octubre | 11 | 3 | 14 |
| 2015 Septiembre | 14 | 1 | 15 |
| 2015 Agosto | 13 | 5 | 18 |
| 2015 Julio | 52 | 1 | 53 |
| 2015 Junio | 24 | 0 | 24 |
| 2015 Mayo | 28 | 3 | 31 |
| 2015 Abril | 20 | 0 | 20 |
| 2015 Marzo | 17 | 1 | 18 |
| 2015 Febrero | 38 | 1 | 39 |
| 2015 Enero | 17 | 0 | 17 |
| 2014 Diciembre | 8 | 0 | 8 |
| 2014 Noviembre | 27 | 0 | 27 |
| 2014 Octubre | 2 | 0 | 2 |
Mostrar todo
