Postoperative Wound Care in Dermatologic Surgery: Update And Narrative Review

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"apellidos" => "Morgado-Carrasco" "email" => array:1 [ 0 => "morgadodaniel8@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Sagrat Cor, Barcelona, España" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, España" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital de Figueres, Fundació Salut Empordà, Figueres, Girona, España" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Cuidado de la herida quirúrgica tras cirugía dermatológica. Una actualización y revisión narrativa" ] ] "textoCompleto" => "IntroductionDermatologic surgery has a low rate of complications,<a class="elsevierStyleCrossRef" href="#bib0325">1</a> with surgical wound infection (SWI) rates between 0.7 and 4.0%, even in the absence of prophylactic antibiotics, preoperative skin preparation, or use of sterile gloves.<a class="elsevierStyleCrossRefs" href="#bib0330">2,3</a> Additionally, SWIs are generally mild and easy to treat.<a class="elsevierStyleCrossRef" href="#bib0330">2</a>The physiological wound healing process is complex, involving neutrophils, macrophages, fibroblasts, and keratinocytes, and consisting of several phases: inflammatory, proliferative, and remodeling (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). In recent years, some studies have suggested that the skin microbiome may also play an important role in the healing process.<a class="elsevierStyleCrossRef" href="#bib0340">4</a> Post-dermatologic surgery wounds care is a controversial topic, and there is no universally accepted protocol to this date. Numerous studies show wide variability in recommendations, such as antiseptic use, topical antibiotics, dressing type, and frequency of care, among others.<a class="elsevierStyleCrossRef" href="#bib0345">5</a><elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The aim of this work is to review the procedures and products recommended for post-dermatologic surgery wound care and discuss the evidence supporting them.MethodsWe conducted a narrative literature review, searching PubMed and Google Scholar in August 2023 using the Spanish and English terms: “dermatologic surgery”; “wound care”; “surgical wound care”; “skin graft”; “direct closure”; “secondary intention closure”; “biomembrane”; “topical antibiotics”; “petrolatum”; “vaseline.” We included prospective and retrospective clinical studies, clinical trials, systematic reviews, and meta-analyses. Articles were selected based on their relevance. Isolated clinical case reports were excluded.ResultsMoisturizers and topical antibioticsA systematic review and meta-analysis—including 4 randomized clinical trials (RCTs) for a total of 4170 excisions—that evaluated the rates of SWI after dermatologic surgery by comparing topical antibiotics vs vaseline or paraffin found no significant differences.<a class="elsevierStyleCrossRef" href="#bib0330">2</a> A recent meta-analysis found no differences either in the rates of SWI in dermatologic, ophthalmologic, orthopedic, and cardiothoracic surgeries.<a class="elsevierStyleCrossRef" href="#bib0350">6</a> Previously, a Cochrane review<a class="elsevierStyleCrossRef" href="#bib0355">7</a> concluded that the use of topical antibiotics could reduce the risk of SWI vs not using them or using antiseptics. However, it included not only dermatologic procedures but also appendectomies, C-sections, trauma, and cardiothoracic surgeries. A RCT with 231 patients undergoing dermatologic surgery—not included in former systematic reviews—evaluated the application of a topical silicone gel vs an ointment consisting of 3 antibiotics (bacitracin, neomycin, and polymyxin B). A similar incidence of SWI was reported. The risk of contact dermatitis was significantly higher in the topical antibiotic group (19%) vs the silicone one (0%)<a class="elsevierStyleCrossRef" href="#bib0360">8</a> (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>A prospective study compared the application of vaseline, a reparative ointment (Aquaphor®), and no ointment in 76 patients undergoing Mohs surgery. The study confirmed a higher incidence of crusting in the no-ointment group along with a higher incidence of erythema and inflammation in the reparative ointment group. Both differences were significant.<a class="elsevierStyleCrossRef" href="#bib0365">9</a>Start and frequency of careIt is generally recommended to keep the wound covered for the first 48hours. However, a multicenter RCT (n=857) evaluated the risk of SWI in patients undergoing dermatologic surgery between early dressing removal and bathing with soap and water 12hours after surgery vs late removal after 48hours, finding no significant differences in the rates of SWI.<a class="elsevierStyleCrossRef" href="#bib0370">10</a>A survey of 64 patients undergoing Mohs surgery reported that hydrocolloid dressings applied for an average of 6.4 days without removal were associated with greater comfort, better scar appearance, and higher satisfaction vs conventional daily dressings. Complications such as infections, fever, and pain were similar in both groups.<a class="elsevierStyleCrossRef" href="#bib0375">11</a> Similarly, studies conducted on patients undergoing dermatologic surgery on the legs, where dressings were changed weekly—using compression bandages and zinc oxide—did not show a higher rate of SWI vs conventional daily care.<a class="elsevierStyleCrossRef" href="#bib0380">12</a>DressingsTraditionally, gauze, bandages, and cotton have been used for postoperative wound coverage. More recently, advanced dressings such as interface films, foams, hydrogels, hydrocolloids, and alginates have been developed (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). Although the frequency of dressing changes depends on the type of dressing, the goal is to space out the care provided.<a class="elsevierStyleCrossRef" href="#bib0385">13</a> A prospective study of 226 small wounds closed by secondary intention, such as shaves and 3mm punch biopsies, showed that the use of advanced occlusive dressings was associated with shorter re-epithelialization time and pain vs traditional dressings.<a class="elsevierStyleCrossRef" href="#bib0390">14</a> Furthermore, as mentioned earlier, the hydrocolloid dressing kept in place for about a week was preferred by the patients over conventional daily care.<a class="elsevierStyleCrossRef" href="#bib0375">11</a><elsevierMultimedia ident="tbl0015"></elsevierMultimedia>AntisepticsWe did not find any studies comparing the use of antiseptics or detergents such as soap, povidone-iodine, hydrogen peroxide, chlorhexidine, and alcohol solutions, among others, for the management of dermatologic surgical wounds.For years, it has been suggested that although povidone-iodine may be toxic to fibroblasts and keratinocytes in vitro,<a class="elsevierStyleCrossRef" href="#bib0395">15</a> no healing delays have ever been confirmed.<a class="elsevierStyleCrossRefs" href="#bib0400">16–19</a> A systematic review described iodine as superior to other antiseptic agents, such as silver sulfadiazine cream and non-antiseptic dressings in reducing bacterial load and was not associated with impaired healing, or long healing time.<a class="elsevierStyleCrossRef" href="#bib0420">20</a>Negative pressure therapyNegative pressure therapy (NPT) may be useful in wound management, offering various advantages (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>). In surgical wounds with primary closure, it has not proven particularly significant.<a class="elsevierStyleCrossRef" href="#bib0425">21</a> We only found 1 study in dermatologic surgery: 1 RCT with 49 patients with grafts on their legs after skin cancer excision compared graft success rates with NPT vs dressing and rest. No significant differences were reported between the 2 groups at the 6- and 12-week follow-ups.<a class="elsevierStyleCrossRef" href="#bib0430">22</a> Nonetheless, one meta-analysis with 10 RCTs including 488 patients with partial-thickness skin grafts (PTSGs) for various indications (burns, traumatic wounds, chronic leg wounds, and oncologic excisions in the legs) reported significant differences in viable graft percentage, shorter time to healing (9.18 days vs 12.5 days in the control group), and lower reintervention rates with NPT.<a class="elsevierStyleCrossRef" href="#bib0435">23</a> Similar results were reported in a former meta-analysis of 5 cohort studies and 7 RCTs (653 patients overall).<a class="elsevierStyleCrossRef" href="#bib0440">24</a><elsevierMultimedia ident="tbl0020"></elsevierMultimedia>For the combination of NPT with xenografts (biomembranes), one RCT with 36 patients with wounds exposing bone or tendon compared the application of the Integra® biomembrane vs the biomembrane plus NPT. They observed significantly superior results with NPT and shorter healing times (p<0.001).<a class="elsevierStyleCrossRef" href="#bib0445">25</a>Special situationsCare of surgical wounds with skin graftsTraditionally, the tie-over bolster dressing (sutured compression dressing-SCD) has been used as a reinforcement technique. Multiple alternatives have been described (<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>), highlighting the non-reinforced coverage, especially in grafts up to 5.5cm2, with results comparable to SCD. Advantages include shorter surgical times and increased patient comfort.<a class="elsevierStyleCrossRefs" href="#bib0450">26–29</a> The graft is covered with a non-adhesive dressing, with or without another non-adhesive contact dressing or rolled gauze impregnated over the graft. It can be secured with sterile bands, elastic bandage, or adhesive dressing.<elsevierMultimedia ident="tbl0025"></elsevierMultimedia>We have not found any studies directly comparing the results between different materials, or between different types of dressings after covering with skin grafts in dermatologic surgery.Donor site wounds for skin graftsA systematic review that included 35 studies comparing different modalities of dressings in the donor site of PTSG—mostly comparing dry dressing (with gauze) vs advanced dressings—reported better pain control and faster healing in the latter group.<a class="elsevierStyleCrossRef" href="#bib0470">30</a> Two previous systematic reviews showed similar results.<a class="elsevierStyleCrossRefs" href="#bib0475">31,32</a> A multicenter RCT with 288 patients with donor site defects, mainly from the thigh and > 10cm2 compared alginate dressings, films, gauze, hydrocolloids, Hydrofiber®, and silicone. They observed that re-epithelialization time with hydrocolloid dressings was 7 days shorter vs other dressings. The rate of SWI with gauze was twice that of other dressings (RR, 2.38; CI, 1.14-4.99).<a class="elsevierStyleCrossRef" href="#bib0485">33</a>Wounds covered with dermal xenograftsBiomembranes or dermal xenografts are used to cover complex defects. They promote neovascularization of the bed, which will later facilitate re-epithelialization by secondary intention, coverage with skin grafts, or flaps. This process usually takes 14 to 21 days. The biomembrane should be kept covered by an external protective layer, usually silicone. We have not found any clinical studies yet on the type of dressings to be performed during this period. Commercial brands recommend occlusive coverage with antimicrobials for the first 5 to 7 days, which is similar to a skin graft. Contact of the graft with enzymatic debridement agents such as collagenase is ill-advised.<a class="elsevierStyleCrossRef" href="#bib0490">34</a>Surgical wounds with secondary intention healingWounds with secondary intention healing (SIH) after dermatological surgery are not associated with a higher risk of SWI than direct closure, according to the results of a recent systematic review.<a class="elsevierStyleCrossRef" href="#bib0495">35</a> In an extensive Cochrane review (14 centers, n=886), a reduction in the risk of SWI in SIH with topical antibiotics was suggested. However, the included studies were small and with different types of wounds, such as post-diabetic foot amputation, pilonidal sinus surgery and hemorrhoids, abscesses, post-C-section complications, and colostomies.<a class="elsevierStyleCrossRef" href="#bib0500">36</a>A systematic review included 13 RCTs comparing different dressings, such as gauze, foam, powders, alginate, and hydrocolloid in SIH. The included wounds were due to the excision of pilonidal cysts, abdominal postoperative complications, and leg amputations. In general, patients experienced more pain and lower satisfaction with the use of gauze. Foam dressings appeared to be superior to conventional gauze in terms of patient satisfaction, pain reduction, and nursing care.<a class="elsevierStyleCrossRef" href="#bib0505">37</a>Surgical wounds on the legsMultiple studies have described a higher rate of complications after dermatological surgery below the knee<a class="elsevierStyleCrossRef" href="#bib0510">38</a> (<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>). Recently, a retrospective study that included 23,121 excisions in dermatological surgery proved that this location was associated with a higher risk of SWI (odds ratio [OR], 1.908; CI, 1.126-3.235) and higher rates of dehiscence (OR, 4.037; CI, 2.654-6.140), which increased significantly if the patient was ≥80 years old (OR, 9.632; CI, 5.635-16.464)<a class="elsevierStyleCrossRef" href="#bib0325">1</a>.<elsevierMultimedia ident="tbl0030"></elsevierMultimedia>Studies on post-dermatologic surgery dressings on the legs are scarce. We found 2 retrospective studies in which zinc oxide and compression was used. A recent study (n=80) evaluated the time until complete healing of the surgical wound with primary closure in individuals undergoing excision of skin lesions on the legs. They compared a group with conventional dressings—gauze and non-adhesive dressings—vs a different group with gauze impregnated with zinc oxide and compression with an elastic bandage (the dressing was changed weekly). By day 19, 66% of patients from the first group and 92% of the zinc oxide+compression group had achieved complete healing (p <0.001). A total of 14% of the group with conventional dressings had complications vs 0 individuals from the zinc oxide+compression group.<a class="elsevierStyleCrossRef" href="#bib0380">12</a> Similar results were found in a small clinical trial (n=10) of patients with surgical wounds left to heal by secondary intention using a Unna boot (a bandage with zinc oxide-impregnated wraps). The dressing was changed weekly.<a class="elsevierStyleCrossRef" href="#bib0515">39</a>For the role of compression, a recent systematic literature review<a class="elsevierStyleCrossRef" href="#bib0520">40</a> found 2 studies evaluating its role in post-dermatologic surgery dressings: the above-mentioned clinical trial using the Unna boot,<a class="elsevierStyleCrossRef" href="#bib0515">39</a> and a retrospective study (n=366) that revealed that pre- and postoperative compression was associated with a statistically nonsignificant lower rate of complications (OR, 0.67).<a class="elsevierStyleCrossRef" href="#bib0525">41</a>DiscussionIn general, the evidence on dressings after dermatological surgery is limited. Some recommendations come from other specialties, which perform procedures that may have higher rates of complications, and therefore, these recommendations may not be generalizable.We found a wide variability of postoperative recommendations among dermatologists. A study analyzed a total of 169 care protocols from 119 centers, mostly American. A total of 84% recommended the application of petroleum-based products, specifically petrolatum (75%) and Aquaphor® (43%), 43% indicated topical antibiotics, and 24% discouraged them.<a class="elsevierStyleCrossRef" href="#bib0345">5</a> A recent survey of 196 dermatologic surgeons proved that 95% recommended some antiseptic for surgical wound care, mainly washing with water and soap (65%), followed by other unspecified antiseptics, hydrogen peroxide, acetic acid, and chlorhexidine.<a class="elsevierStyleCrossRef" href="#bib0530">42</a>The ideal dressing should be hemostatic, protective against infections, immobilizing, moist, and absorbent of excess exudate. Comparative studies of gauze vs advanced dressings come mainly from general surgery and chronic or traumatic wounds. In general, no differences in healing time, aesthetic outcomes, or SWI have been demonstrated.<a class="elsevierStyleCrossRef" href="#bib0385">13</a>,<a class="elsevierStyleCrossRef" href="#bib0535">43</a> In dermatology, although evidence is limited, advanced dressings may be more comfortable for the patient and require fewer dressing changes,<a class="elsevierStyleCrossRef" href="#bib0375">11</a> but at a higher cost.Dermatology is one of the specialties that most prescribes antibiotics.<a class="elsevierStyleCrossRef" href="#bib0540">44</a> The use of prophylactic topical antibiotics is not recommended for clean dermatological surgical wounds.<a class="elsevierStyleCrossRefs" href="#bib0355">7,8,45–48</a> In addition to not being beneficial, their use may be associated with bacterial resistance and the development of allergic contact dermatitis.<a class="elsevierStyleCrossRef" href="#bib0360">8</a> Necrosis of the wound has even been reported with the use of mupirocin.<a class="elsevierStyleCrossRef" href="#bib0550">46</a> In general, petrolatum or topical silicone is preferred instead.<a class="elsevierStyleCrossRefs" href="#bib0330">2,6,8,49</a>Despite the lack of evidence, in SIH and skin grafts, an emollient like petrolatum and an occlusive or semi-occlusive dressing may be used to prevent desiccation and infection.<a class="elsevierStyleCrossRef" href="#bib0570">50</a> Skin grafts should remain covered for 5 to 7 days. Once the dressing has been removed, it is suggested to keep the wound hydrated and clean. A survey of 294 Mohs surgeons revealed that most recommended petroleum jelly or Aquaphor® for care (64% and 38%, respectively), and that more than 85% did not change this recommendation in SIH or grafts.<a class="elsevierStyleCrossRef" href="#bib0575">51</a>For postoperative wounds below the knee, the combination of zinc oxide and compression seems to be a good option. Although compression is widely recommended to treat venous ulcers in this location, its evidence in surgical wounds is scarce.<a class="elsevierStyleCrossRef" href="#bib0380">12</a> In a recent study, only 7.5% of patients with dermatological surgical wounds below the knee received postoperative compression.<a class="elsevierStyleCrossRef" href="#bib0580">52</a><a class="elsevierStyleCrossRef" href="#tbl0035">Table 7</a> illustrates recommendations and their level of evidence in the management of wounds after dermatologic surgery.<elsevierMultimedia ident="tbl0035"></elsevierMultimedia>In general, patients follow post-dermatologic surgery wound care instructions. However, a significant number of patients—especially the elderly—have difficulty understanding them, highlighting the need to explain them adequately and adapt them to their social reality.<a class="elsevierStyleCrossRefs" href="#bib0585">53,54</a>LimitationsThis review is limited by being a narrative and not a systematic literature review. The studies included are methodologically heterogeneous, and in many cases, there are no comparative studies across the various agents/procedures. Furthermore, clinical trials on the topic are scarce.ConclusionsThere is significant variability in postoperative wound care recommendations in dermatology. The evidence on the superiority of different agents and techniques is, in most cases, limited. However, there is sufficient evidence to discourage the use of prophylactic topical antibiotics. The use of petrolatum or silicone gel offers similar results, with lower complication rates. Although advanced dressings may be more comfortable than conventional ones due to less frequent changes, they are not superior in terms of healing time or incidence of SWI. In SIH, foam dressings appear to be superior to conventional gauze. Prospective comparative studies are needed to provide evidence-based recommendations.FundingNone declared.Conflicts of interestNone declared." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres2262986" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1889424" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2262987" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1889425" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Results" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Moisturizers and topical antibiotics" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Start and frequency of care" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Dressings" ] 3 => array:2 [ "identificador" => "sec0035" "titulo" => "Antiseptics" ] 4 => array:2 [ "identificador" => "sec0040" "titulo" => "Negative pressure therapy" ] 5 => array:3 [ "identificador" => "sec0045" "titulo" => "Special situations" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0050" "titulo" => "Care of surgical wounds with skin grafts" ] 1 => array:2 [ "identificador" => "sec0055" "titulo" => "Donor site wounds for skin grafts" ] 2 => array:2 [ "identificador" => "sec0060" "titulo" => "Wounds covered with dermal xenografts" ] 3 => array:2 [ "identificador" => "sec0065" "titulo" => "Surgical wounds with secondary intention healing" ] 4 => array:2 [ "identificador" => "sec0070" "titulo" => "Surgical wounds on the legs" ] ] ] ] ] 7 => array:2 [ "identificador" => "sec0075" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0080" "titulo" => "Limitations" ] 9 => array:2 [ "identificador" => "sec0085" "titulo" => "Conclusions" ] 10 => array:2 [ "identificador" => "sec0090" "titulo" => "Funding" ] 11 => array:2 [ "identificador" => "sec0095" "titulo" => "Conflicts of interest" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-11-27" "fechaAceptado" => "2024-05-08" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1889424" "palabras" => array:5 [ 0 => "Wound care" 1 => "Dermatologic surgery" 2 => "Mohs surgery" 3 => "Dressings" 4 => "Grafts" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1889425" "palabras" => array:6 [ 0 => "Curas" 1 => "Herida quirúrgica" 2 => "Cirugía dermatológica" 3 => "Cirugía de Mohs" 4 => "Apósitos" 5 => "Injertos" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "Dermatologic surgery is associated with a very low risk of complications. There is no widely accepted, evidence-based protocol with recommendations for postoperative wound care after dermatologic surgery. In this narrative review, we will be discussing the evidence on surgical wound care products and procedures. Overall, we found relatively few studies and, in many cases, a lack of statistically significant differences, possibly because of the low rate of complications. We’ll be discussing the evidence on when we should initiate wound care procedures and their frequency, the type of ointment and antiseptics that should be applied, and the type of dressings that should be used. Despite the very few studies available on postoperative wound care following dermatologic surgery, there is sufficient evidence as to not recommend the use of prophylactic topical antibiotics. We also analyze the currently available evidence on surgical wound care in special situations, such as management of skin grafts, partial skin graft donor sites, xenografts/biomembranes, and surgical wounds to the legs." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "La cirugía dermatológica asocia un riesgo de complicaciones muy bajo. No existe un protocolo universalmente aceptado sobre las recomendaciones de curas poscirugía dermatológica. En esta revisión narrativa, discutimos la evidencia sobre productos y procedimientos para el cuidado de la herida quirúrgica. En general, encontramos escasos estudios y en muchas ocasiones, falta de diferencias estadísticamente significativas, posiblemente dada la baja tasa de complicaciones. Discutimos la evidencia sobre cuándo iniciar las curas y su frecuencia, el tipo de ungüento a aplicar, los antisépticos y el tipo de apósito a utilizar. Pese a los escasos estudios sobre las curas tras cirugía dermatológica, existe evidencia suficiente para desaconsejar la utilización de antibióticos tópicos profilácticos. También analizamos la evidencia publicada sobre el cuidado de la herida quirúrgica en situaciones especiales, como son los injertos cutáneos, las zonas dadoras de injertos cutáneos de espesor parcial, los xenoinjertos/biomembranas y las heridas quirúrgicas en las piernas." ] ] "multimedia" => array:7 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Common phases in wounds<a class="elsevierStyleCrossRef" href="#bib0595">55</a></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hemostasis and early inflammation (first 4 to 6 days) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The damaged blood vessel constricts, and the surrounding endothelium and platelets activate the coagulation cascade. The clot releases cytokines and growth factors that initiate the inflammatory response. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chemotaxis and macrophage activation (48 to 96 hours) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The clot recruits neutrophils, which release proteolytic substances to degrade bacteria and excess tissue. The accumulation of inflammatory mediators activates macrophages, which participate in the onset of angiogenesis. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Proliferative phase: re-epithelialization, angiogenesis, and granulation (days 4 to 14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Maturation and remodeling (Day 8 to 1 year) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Epithelialization is initially stimulated by fibroblasts, occurring from the edges of the epithelium toward the center of the wound.Vascular endothelial growth factor (VEGF), mainly secreted by keratinocytes in response to hypoxia, stimulates the formation of new capillaries.Hypoxia in endothelial cells promotes the secretion of nitric oxide, which causes vasodilation.Fibroblasts migrate to the wound, activate, synthesize collagen, proliferate, and transform into myofibroblasts, which will eventually cause wound contraction.Initially, the matrix is composed mainly of fibrin and fibronectin. Subsequently, fibroblasts synthesize a provisional, disorganized matrix of glycosaminoglycans, proteoglycans, and other proteins.This temporary matrix is eventually replaced by a stronger and more organized collagen matrix. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Phases associated with skin grafts</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Plasma imbibition phase (first 24 to 48 hours) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The graft is fixed to the receptor bed, allowing it to absorb exudate and remain hydrated and nourished during the avascular phase. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Inosculation (48 to 72 hours) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Anastomosis between the receptor bed and the dermal vessels of the graft. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Neovascularization and blood flow bridging between graft and bed (up to 4 to 7 days) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Re-epithelialization (From day 4-8 to several weeks later) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3679508.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Physiological process of wound healing." ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "RCT, randomized clinical trial; MMS, Mohs micrographic surgery; SWI, surgical would infection." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Author and year \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Study type \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Number of wounds \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Intervention \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Main results \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Smack et al., 1996<a class="elsevierStyleCrossRef" href="#bib0545">45</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RCT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1249 dermatological wounds \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Comparison of petroleum jelly vs bacitracin ointment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- No significant differences in the rates of surgical wound infection (2.0% vs 0.9%; p = 0.37). - No significant differences in contact dermatitis rates (0% vs 0.9%; p = 0.12). - No significant postoperative differences in healing between treatment groups on day 1 (p = 0.98), day 7 (p = 0.86), or day 28 (p = 0.28) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dixon et al., 2006<a class="elsevierStyleCrossRef" href="#bib0550">46</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RCT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1801 surgical wounds \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Comparison of no ointment before the postoperative dressing vs petroleum jelly vs mupirocin ointment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- No significant differences in infection rates (1.4%, 1.6%, and 2.3%, respectively; p = 0.490). - No significant differences in the rates of complications (including the rates of bleeding, scarring, dehiscence, and SWI; 3.5%, 4.7%, and 4.8%, respectively; p = 0.590). - No differences in postoperative pain, discomfort level, or overall satisfaction with treatment. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Heal et al., 2009<a class="elsevierStyleCrossRef" href="#bib0600">56</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RCT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">972 minor dermatological surgeries \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Comparison of paraffin vs chloramphenicol ointment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- The incidence of SWI was significantly lower in the chloramphenicol group (6.6%) vs the control one (11.0%) (p = 0.010). \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Taylor et al., 2011<a class="elsevierStyleCrossRef" href="#bib0555">47</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prospective split-face study \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 patients with 2 facial papulosis nigra lesions \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Comparison of repair ointment (Aquaphor®) on one lesion vs antibiotic ointment (polymyxin B/bacitracin) on a different lesion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- No SWI reported. - No observed differences in erythema, edema, re-epithelialization, crusting, hyperpigmentation, irritation, or pain. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Draelos et al., 2011<a class="elsevierStyleCrossRef" href="#bib0560">48</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prospective split-face study \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 patients with 2 seborrheic keratoses on the trunk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Comparison of repair ointment (Aquaphor®) on one lesion vs antibiotic ointment (polymyxin B/bacitracin) on a different lesion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- No SWI reported. - No differences in erythema, edema, re-epithelialization, or crust formation. - Greater subjective irritation reported in the antibiotic group within the first week. - 1 case of allergic contact dermatitis with antibiotics was reported \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Benedetto et al., 2021<a class="elsevierStyleCrossRef" href="#bib0360">8</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RCT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">231 (67 underwent MMS and 164 various dermatological procedures) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Comparison of silicone gel (Stratamed®) vs a product with 3 topical antibiotics (Neosporin®) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- No significant differences in the rates of SWI. - The antibiotic product was associated with 19% contact dermatitis (0% in the silicone group) (p < 0.001). - Healing time and tissue quality were better with silicone gel. \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3679504.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Prospective studies on the use of topical antibiotics on post-dermatologic procedure wound infection rates." ] ] 2 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Type \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Composition \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Characteristics \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Indications \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Change frequency \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Film \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Polyurethane or copolyester with acrylic adhesive backing. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Permeable to gas but not to liquid water and bacteria.- Highly moisturizing, no absorbent capacity. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dry wounds. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Few times a week, up to 7 days. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hydrogel \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cross-linked starch polymers in 80% up to 90% water base. Available as fluid gels, flexible sheets, and impregnated gauze.No adhesive backing. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Semi-permeable to gases and fluids. - Highly moisturizing. - Promotes autolytic debridement, granulation, and re-epithelialization. - Limited absorbent capacity. - Reduces temperature by about 5°C, which may decrease pain perception. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Wounds with light exudate or dry wounds. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Every 1 to 3 days, depending on wound hydration.Care is advised to avoid maceration of surrounding skin. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hydrocolloid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hydrophilic and adhesive matrix of polymers such as gelatin and pectin, with an outer layer of polyurethane. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Semi-permeable to water and gas, but impermeable to fluids and bacteria. - Moisturizing. - Promotes autolytic debridement, angiogenesis, granulation, and re-epithelialization. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Wounds with light to moderate exudate. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Initially once a day, then every 3 to 7 days. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Foam \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Opaque polyurethane or sponge-like polymer with a semi-occlusive and hydrophobic backing. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Permeable to gas, but not to liquid water and bacteria. - Highly absorbent. - Provides cushioning and thermal insulation. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Wounds with moderate-to-severe exudate. - Wounds covered by granulation tissue or skin. - Donor site for graft. - Secondary intention wounds.<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">From once a day to once or twice a week. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Alginate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Alginate acid fibers (similar to cellulose but marine-derived) covered with calcium and sodium salts.No adhesive backing. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Highly absorbent. - Not moisturizing. - Sodium ions from exudate are exchanged for calcium from the dressing, forming a hydrophilic gel. - Calcium activates prothrombin and the coagulation cascade. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Highly exudative wounds. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">From week 1 or until the gel loses viscosity. \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3679510.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Foam dressings have proven beneficial in surgical wounds healing by secondary intention, in terms of reducing healing time, pain, and nursing interventions vs conventional gauzes.<a class="elsevierStyleCrossRef" href="#bib0505">37</a> Source: Axibal and Brown.<a class="elsevierStyleCrossRef" href="#bib0385">13</a>" ] ] ] "descripcion" => array:1 [ "en" => "Types of advanced dressings." ] ] 3 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mechanism of Action<a class="elsevierStyleCrossRef" href="#bib0605">57</a> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Potential advantages in postoperative wound care<a class="elsevierStyleCrossRef" href="#bib0610">58</a> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Increases capillary flow \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Reduces shear forces \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Promotes granulation tissue \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Restricts seroma and hematoma formation \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Decreases bacterial load \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- May increase patient comfort \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Maintains a moist environment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- May reduce epithelialization time \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Removes excess exudate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3679506.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Mechanism of action and potential advantages of negative pressure therapy in postoperative wound care." ] ] 4 => array:8 [ "identificador" => "tbl0025" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at5" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Fixation technique \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Material in contact with the graft \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Sutured compression dressing (SCD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Petrolatum-impregnated gauze<a class="elsevierStyleCrossRef" href="#bib0635">63</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Continuous reinforcement suture<a class="elsevierStyleCrossRef" href="#bib0615">59</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Antibiotic-impregnated gauze or iodine povidone gauze<a class="elsevierStyleCrossRef" href="#bib0415">19</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Reinforcement with Telfa® and staples<a class="elsevierStyleCrossRef" href="#bib0450">26</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Bismuth tribromophenate-impregnated gauze (XeroformTM)<a class="elsevierStyleCrossRef" href="#bib0465">29</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Reinforcement with polyurethane foam<a class="elsevierStyleCrossRefs" href="#bib0620">60,61</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Non-adhesive contact dressings (MepitelTM)<a class="elsevierStyleCrossRefs" href="#bib0355">7–9</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Unreinforced coverage<a class="elsevierStyleCrossRefs" href="#bib0355">7–9</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Foam<a class="elsevierStyleCrossRef" href="#bib0620">60</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Mattress sutures<a class="elsevierStyleCrossRef" href="#bib0630">62</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Sponges<a class="elsevierStyleCrossRef" href="#bib0620">60</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- “Sandwich” suture for nasal wing defects<a class="elsevierStyleCrossRef" href="#bib0635">63</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3679509.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Techniques for fixing skin grafts and materials in contact with the graft." ] ] 5 => array:8 [ "identificador" => "tbl0030" "etiqueta" => "Table 6" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at6" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Sources: Rosengren et al.<a class="elsevierStyleCrossRef" href="#bib0640">64</a>, Schlager et al.<a class="elsevierStyleCrossRef" href="#bib0495">35</a> and Pynn et al.<a class="elsevierStyleCrossRef" href="#bib0510">38</a>." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Wound characteristics \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patient characteristics \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Wound location \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Surgical complexity \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Bacterial contamination \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Diabetes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Below the knee \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Prolonged duration \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Hair around \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Obesity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Groin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Flap creation \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Extensive inflammatory skin disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Smoking habit \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Genitals \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Use of grafts \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Chronic kidney disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Nose \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Longer scar \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Carrier of nasal S. aureus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Ear \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3679505.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Factors associated with increased risk of surgical wound infection." ] ] 6 => array:8 [ "identificador" => "tbl0035" "etiqueta" => "Table 7" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at7" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "NPT, negative pressure therapy." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Recommendation \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Level of evidence<a class="elsevierStyleCrossRef" href="#tblfn0010">a</a> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Grade of recommendation<a class="elsevierStyleCrossRef" href="#tblfn0010">a</a> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Avoid prophylactic topical antibiotics \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Apply petroleum jelly as a moisturizer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Apply silicone gel as a moisturizer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">D \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Wash the wound early 12hours after surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">C \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prefer advanced dressings \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">D \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Use antiseptics in dressings \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">D \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Use NPT on xenografts (biomembranes) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">D \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Use hydrocolloid dressings on the graft donor site \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Use non-reinforced coverage on the grafts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">D \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Use compression bandages on the legs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">D \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3679507.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "a" "nota" => "According to the Scottish Intercollegiate Guidelines Network (SIGN)." ] ] ] "descripcion" => array:1 [ "en" => "Recommendations for managing wounds after dermatological surgery." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:64 [ 0 => array:3 [ "identificador" => "bib0325" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Complications in dermatologic surgery: A case-control study exploring factors associated with postsurgical infection and wound dehiscence in a large national group practice" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "T.P. 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Practical Dermatology

Postoperative Wound Care in Dermatologic Surgery: Update And Narrative Review

Cuidado de la herida quirúrgica tras cirugía dermatológica. Una actualización y revisión narrativa

A. Sanchez-Puigdollersa,b, A. Tollb, D. Morgado-Carrascob,c,

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morgadodaniel8@gmail.com

Corresponding author.

a Servicio de Dermatología, Hospital Sagrat Cor, Barcelona, España

b Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, España

c Servicio de Dermatología, Hospital de Figueres, Fundació Salut Empordà, Figueres, Girona, España

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Dermatologic surgery has a low rate of complications&#44;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">1</span></a> with surgical wound infection &#40;SWI&#41; rates between 0&#46;7 and 4&#46;0&#37;&#44; even in the absence of prophylactic antibiotics&#44; preoperative skin preparation&#44; or use of sterile gloves&#46;<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">2&#44;3</span></a> Additionally&#44; SWIs are generally mild and easy to treat&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The physiological wound healing process is complex&#44; involving neutrophils&#44; macrophages&#44; fibroblasts&#44; and keratinocytes&#44; and consisting of several phases&#58; inflammatory&#44; proliferative&#44; and remodeling &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; In recent years&#44; some studies have suggested that the skin microbiome may also play an important role in the healing process&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">4</span></a> Post-dermatologic surgery wounds care is a controversial topic&#44; and there is no universally accepted protocol to this date&#46; Numerous studies show wide variability in recommendations&#44; such as antiseptic use&#44; topical antibiotics&#44; dressing type&#44; and frequency of care&#44; among others&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">5</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The aim of this work is to review the procedures and products recommended for post-dermatologic surgery wound care and discuss the evidence supporting them&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">We conducted a narrative literature review&#44; searching PubMed and Google Scholar in August 2023 using the Spanish and English terms&#58; &#8220;dermatologic surgery&#8221;&#59; &#8220;wound care&#8221;&#59; &#8220;surgical wound care&#8221;&#59; &#8220;skin graft&#8221;&#59; &#8220;direct closure&#8221;&#59; &#8220;secondary intention closure&#8221;&#59; &#8220;biomembrane&#8221;&#59; &#8220;topical antibiotics&#8221;&#59; &#8220;petrolatum&#8221;&#59; &#8220;vaseline&#46;&#8221; We included prospective and retrospective clinical studies&#44; clinical trials&#44; systematic reviews&#44; and meta-analyses&#46; Articles were selected based on their relevance&#46; Isolated clinical case reports were excluded&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Results</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Moisturizers and topical antibiotics</span><p id="par0025" class="elsevierStylePara elsevierViewall">A systematic review and meta-analysis&#8212;including 4 randomized clinical trials &#40;RCTs&#41; for a total of 4170 excisions&#8212;that evaluated the rates of SWI after dermatologic surgery by comparing topical antibiotics vs vaseline or paraffin found no significant differences&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">2</span></a> A recent meta-analysis found no differences either in the rates of SWI in dermatologic&#44; ophthalmologic&#44; orthopedic&#44; and cardiothoracic surgeries&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">6</span></a> Previously&#44; a Cochrane review<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">7</span></a> concluded that the use of topical antibiotics could reduce the risk of SWI vs not using them or using antiseptics&#46; However&#44; it included not only dermatologic procedures but also appendectomies&#44; C-sections&#44; trauma&#44; and cardiothoracic surgeries&#46; A RCT with 231 patients undergoing dermatologic surgery&#8212;not included in former systematic reviews&#8212;evaluated the application of a topical silicone gel vs an ointment consisting of 3 antibiotics &#40;bacitracin&#44; neomycin&#44; and polymyxin B&#41;&#46; A similar incidence of SWI was reported&#46; The risk of contact dermatitis was significantly higher in the topical antibiotic group &#40;19&#37;&#41; vs the silicone one &#40;0&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">8</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">A prospective study compared the application of vaseline&#44; a reparative ointment &#40;Aquaphor&#174;&#41;&#44; and no ointment in 76 patients undergoing Mohs surgery&#46; The study confirmed a higher incidence of crusting in the no-ointment group along with a higher incidence of erythema and inflammation in the reparative ointment group&#46; Both differences were significant&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">9</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Start and frequency of care</span><p id="par0035" class="elsevierStylePara elsevierViewall">It is generally recommended to keep the wound covered for the first 48<span class="elsevierStyleHsp" style=""></span>hours&#46; However&#44; a multicenter RCT &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>857&#41; evaluated the risk of SWI in patients undergoing dermatologic surgery between early dressing removal and bathing with soap and water 12<span class="elsevierStyleHsp" style=""></span>hours after surgery vs late removal after 48<span class="elsevierStyleHsp" style=""></span>hours&#44; finding no significant differences in the rates of SWI&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">10</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">A survey of 64 patients undergoing Mohs surgery reported that hydrocolloid dressings applied for an average of 6&#46;4 days without removal were associated with greater comfort&#44; better scar appearance&#44; and higher satisfaction vs conventional daily dressings&#46; Complications such as infections&#44; fever&#44; and pain were similar in both groups&#46;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">11</span></a> Similarly&#44; studies conducted on patients undergoing dermatologic surgery on the legs&#44; where dressings were changed weekly&#8212;using compression bandages and zinc oxide&#8212;did not show a higher rate of SWI vs conventional daily care&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">12</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Dressings</span><p id="par0045" class="elsevierStylePara elsevierViewall">Traditionally&#44; gauze&#44; bandages&#44; and cotton have been used for postoperative wound coverage&#46; More recently&#44; advanced dressings such as interface films&#44; foams&#44; hydrogels&#44; hydrocolloids&#44; and alginates have been developed &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; Although the frequency of dressing changes depends on the type of dressing&#44; the goal is to space out the care provided&#46;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">13</span></a> A prospective study of 226 small wounds closed by secondary intention&#44; such as shaves and 3<span class="elsevierStyleHsp" style=""></span>mm punch biopsies&#44; showed that the use of advanced occlusive dressings was associated with shorter re-epithelialization time and pain vs traditional dressings&#46;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">14</span></a> Furthermore&#44; as mentioned earlier&#44; the hydrocolloid dressing kept in place for about a week was preferred by the patients over conventional daily care&#46;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">11</span></a></p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Antiseptics</span><p id="par0050" class="elsevierStylePara elsevierViewall">We did not find any studies comparing the use of antiseptics or detergents such as soap&#44; povidone-iodine&#44; hydrogen peroxide&#44; chlorhexidine&#44; and alcohol solutions&#44; among others&#44; for the management of dermatologic surgical wounds&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">For years&#44; it has been suggested that although povidone-iodine may be toxic to fibroblasts and keratinocytes in vitro&#44;<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">15</span></a> no healing delays have ever been confirmed&#46;<a class="elsevierStyleCrossRefs" href="#bib0400"><span class="elsevierStyleSup">16&#8211;19</span></a> A systematic review described iodine as superior to other antiseptic agents&#44; such as silver sulfadiazine cream and non-antiseptic dressings in reducing bacterial load and was not associated with impaired healing&#44; or long healing time&#46;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">20</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Negative pressure therapy</span><p id="par0060" class="elsevierStylePara elsevierViewall">Negative pressure therapy &#40;NPT&#41; may be useful in wound management&#44; offering various advantages &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46; In surgical wounds with primary closure&#44; it has not proven particularly significant&#46;<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">21</span></a> We only found 1 study in dermatologic surgery&#58; 1 RCT with 49 patients with grafts on their legs after skin cancer excision compared graft success rates with NPT vs dressing and rest&#46; No significant differences were reported between the 2 groups at the 6- and 12-week follow-ups&#46;<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">22</span></a> Nonetheless&#44; one meta-analysis with 10 RCTs including 488 patients with partial-thickness skin grafts &#40;PTSGs&#41; for various indications &#40;burns&#44; traumatic wounds&#44; chronic leg wounds&#44; and oncologic excisions in the legs&#41; reported significant differences in viable graft percentage&#44; shorter time to healing &#40;9&#46;18 days vs 12&#46;5 days in the control group&#41;&#44; and lower reintervention rates with NPT&#46;<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">23</span></a> Similar results were reported in a former meta-analysis of 5 cohort studies and 7 RCTs &#40;653 patients overall&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">24</span></a></p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">For the combination of NPT with xenografts &#40;biomembranes&#41;&#44; one RCT with 36 patients with wounds exposing bone or tendon compared the application of the Integra&#174; biomembrane vs the biomembrane plus NPT&#46; They observed significantly superior results with NPT and shorter healing times &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">25</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Special situations</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Care of surgical wounds with skin grafts</span><p id="par0070" class="elsevierStylePara elsevierViewall">Traditionally&#44; the tie-over bolster dressing &#40;sutured compression dressing-SCD&#41; has been used as a reinforcement technique&#46; Multiple alternatives have been described &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41;&#44; highlighting the non-reinforced coverage&#44; especially in grafts up to 5&#46;5<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>&#44; with results comparable to SCD&#46; Advantages include shorter surgical times and increased patient comfort&#46;<a class="elsevierStyleCrossRefs" href="#bib0450"><span class="elsevierStyleSup">26&#8211;29</span></a> The graft is covered with a non-adhesive dressing&#44; with or without another non-adhesive contact dressing or rolled gauze impregnated over the graft&#46; It can be secured with sterile bands&#44; elastic bandage&#44; or adhesive dressing&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">We have not found any studies directly comparing the results between different materials&#44; or between different types of dressings after covering with skin grafts in dermatologic surgery&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Donor site wounds for skin grafts</span><p id="par0080" class="elsevierStylePara elsevierViewall">A systematic review that included 35 studies comparing different modalities of dressings in the donor site of PTSG&#8212;mostly comparing dry dressing &#40;with gauze&#41; vs advanced dressings&#8212;reported better pain control and faster healing in the latter group&#46;<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">30</span></a> Two previous systematic reviews showed similar results&#46;<a class="elsevierStyleCrossRefs" href="#bib0475"><span class="elsevierStyleSup">31&#44;32</span></a> A multicenter RCT with 288 patients with donor site defects&#44; mainly from the thigh and &#62; 10<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span> compared alginate dressings&#44; films&#44; gauze&#44; hydrocolloids&#44; Hydrofiber&#174;&#44; and silicone&#46; They observed that re-epithelialization time with hydrocolloid dressings was 7 days shorter vs other dressings&#46; The rate of SWI with gauze was twice that of other dressings &#40;RR&#44; 2&#46;38&#59; CI&#44; 1&#46;14-4&#46;99&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">33</span></a></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Wounds covered with dermal xenografts</span><p id="par0085" class="elsevierStylePara elsevierViewall">Biomembranes or dermal xenografts are used to cover complex defects&#46; They promote neovascularization of the bed&#44; which will later facilitate re-epithelialization by secondary intention&#44; coverage with skin grafts&#44; or flaps&#46; This process usually takes 14 to 21 days&#46; The biomembrane should be kept covered by an external protective layer&#44; usually silicone&#46; We have not found any clinical studies yet on the type of dressings to be performed during this period&#46; Commercial brands recommend occlusive coverage with antimicrobials for the first 5 to 7 days&#44; which is similar to a skin graft&#46; Contact of the graft with enzymatic debridement agents such as collagenase is ill-advised&#46;<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">34</span></a></p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Surgical wounds with secondary intention healing</span><p id="par0090" class="elsevierStylePara elsevierViewall">Wounds with secondary intention healing &#40;SIH&#41; after dermatological surgery are not associated with a higher risk of SWI than direct closure&#44; according to the results of a recent systematic review&#46;<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">35</span></a> In an extensive Cochrane review &#40;14 centers&#44; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>886&#41;&#44; a reduction in the risk of SWI in SIH with topical antibiotics was suggested&#46; However&#44; the included studies were small and with different types of wounds&#44; such as post-diabetic foot amputation&#44; pilonidal sinus surgery and hemorrhoids&#44; abscesses&#44; post-C-section complications&#44; and colostomies&#46;<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">36</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">A systematic review included 13 RCTs comparing different dressings&#44; such as gauze&#44; foam&#44; powders&#44; alginate&#44; and hydrocolloid in SIH&#46; The included wounds were due to the excision of pilonidal cysts&#44; abdominal postoperative complications&#44; and leg amputations&#46; In general&#44; patients experienced more pain and lower satisfaction with the use of gauze&#46; Foam dressings appeared to be superior to conventional gauze in terms of patient satisfaction&#44; pain reduction&#44; and nursing care&#46;<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">37</span></a></p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Surgical wounds on the legs</span><p id="par0100" class="elsevierStylePara elsevierViewall">Multiple studies have described a higher rate of complications after dermatological surgery below the knee<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">38</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>&#41;&#46; Recently&#44; a retrospective study that included 23&#44;121 excisions in dermatological surgery proved that this location was associated with a higher risk of SWI &#40;odds ratio &#91;OR&#93;&#44; 1&#46;908&#59; CI&#44; 1&#46;126-3&#46;235&#41; and higher rates of dehiscence &#40;OR&#44; 4&#46;037&#59; CI&#44; 2&#46;654-6&#46;140&#41;&#44; which increased significantly if the patient was &#8805;<span class="elsevierStyleHsp" style=""></span>80 years old &#40;OR&#44; 9&#46;632&#59; CI&#44; 5&#46;635-16&#46;464&#41;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">1</span></a>&#46;</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">Studies on post-dermatologic surgery dressings on the legs are scarce&#46; We found 2 retrospective studies in which zinc oxide and compression was used&#46; A recent study &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>80&#41; evaluated the time until complete healing of the surgical wound with primary closure in individuals undergoing excision of skin lesions on the legs&#46; They compared a group with conventional dressings&#8212;gauze and non-adhesive dressings&#8212;vs a different group with gauze impregnated with zinc oxide and compression with an elastic bandage &#40;the dressing was changed weekly&#41;&#46; By day 19&#44; 66&#37; of patients from the first group and 92&#37; of the zinc oxide<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>compression group had achieved complete healing &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; A total of 14&#37; of the group with conventional dressings had complications vs 0 individuals from the zinc oxide<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>compression group&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">12</span></a> Similar results were found in a small clinical trial &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10&#41; of patients with surgical wounds left to heal by secondary intention using a Unna boot &#40;a bandage with zinc oxide-impregnated wraps&#41;&#46; The dressing was changed weekly&#46;<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">39</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">For the role of compression&#44; a recent systematic literature review<a class="elsevierStyleCrossRef" href="#bib0520"><span class="elsevierStyleSup">40</span></a> found 2 studies evaluating its role in post-dermatologic surgery dressings&#58; the above-mentioned clinical trial using the Unna boot&#44;<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">39</span></a> and a retrospective study &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>366&#41; that revealed that pre- and postoperative compression was associated with a statistically nonsignificant lower rate of complications &#40;OR&#44; 0&#46;67&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0525"><span class="elsevierStyleSup">41</span></a></p></span></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0115" class="elsevierStylePara elsevierViewall">In general&#44; the evidence on dressings after dermatological surgery is limited&#46; Some recommendations come from other specialties&#44; which perform procedures that may have higher rates of complications&#44; and therefore&#44; these recommendations may not be generalizable&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">We found a wide variability of postoperative recommendations among dermatologists&#46; A study analyzed a total of 169 care protocols from 119 centers&#44; mostly American&#46; A total of 84&#37; recommended the application of petroleum-based products&#44; specifically petrolatum &#40;75&#37;&#41; and Aquaphor&#174; &#40;43&#37;&#41;&#44; 43&#37; indicated topical antibiotics&#44; and 24&#37; discouraged them&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">5</span></a> A recent survey of 196 dermatologic surgeons proved that 95&#37; recommended some antiseptic for surgical wound care&#44; mainly washing with water and soap &#40;65&#37;&#41;&#44; followed by other unspecified antiseptics&#44; hydrogen peroxide&#44; acetic acid&#44; and chlorhexidine&#46;<a class="elsevierStyleCrossRef" href="#bib0530"><span class="elsevierStyleSup">42</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">The ideal dressing should be hemostatic&#44; protective against infections&#44; immobilizing&#44; moist&#44; and absorbent of excess exudate&#46; Comparative studies of gauze vs advanced dressings come mainly from general surgery and chronic or traumatic wounds&#46; In general&#44; no differences in healing time&#44; aesthetic outcomes&#44; or SWI have been demonstrated&#46;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">13</span></a>&#44;<a class="elsevierStyleCrossRef" href="#bib0535"><span class="elsevierStyleSup">43</span></a> In dermatology&#44; although evidence is limited&#44; advanced dressings may be more comfortable for the patient and require fewer dressing changes&#44;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">11</span></a> but at a higher cost&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Dermatology is one of the specialties that most prescribes antibiotics&#46;<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">44</span></a> The use of prophylactic topical antibiotics is not recommended for clean dermatological surgical wounds&#46;<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">7&#44;8&#44;45&#8211;48</span></a> In addition to not being beneficial&#44; their use may be associated with bacterial resistance and the development of allergic contact dermatitis&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">8</span></a> Necrosis of the wound has even been reported with the use of mupirocin&#46;<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">46</span></a> In general&#44; petrolatum or topical silicone is preferred instead&#46;<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">2&#44;6&#44;8&#44;49</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">Despite the lack of evidence&#44; in SIH and skin grafts&#44; an emollient like petrolatum and an occlusive or semi-occlusive dressing may be used to prevent desiccation and infection&#46;<a class="elsevierStyleCrossRef" href="#bib0570"><span class="elsevierStyleSup">50</span></a> Skin grafts should remain covered for 5 to 7 days&#46; Once the dressing has been removed&#44; it is suggested to keep the wound hydrated and clean&#46; A survey of 294 Mohs surgeons revealed that most recommended petroleum jelly or Aquaphor&#174; for care &#40;64&#37; and 38&#37;&#44; respectively&#41;&#44; and that more than 85&#37; did not change this recommendation in SIH or grafts&#46;<a class="elsevierStyleCrossRef" href="#bib0575"><span class="elsevierStyleSup">51</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">For postoperative wounds below the knee&#44; the combination of zinc oxide and compression seems to be a good option&#46; Although compression is widely recommended to treat venous ulcers in this location&#44; its evidence in surgical wounds is scarce&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">12</span></a> In a recent study&#44; only 7&#46;5&#37; of patients with dermatological surgical wounds below the knee received postoperative compression&#46;<a class="elsevierStyleCrossRef" href="#bib0580"><span class="elsevierStyleSup">52</span></a><a class="elsevierStyleCrossRef" href="#tbl0035">Table 7</a> illustrates recommendations and their level of evidence in the management of wounds after dermatologic surgery&#46;</p><elsevierMultimedia ident="tbl0035"></elsevierMultimedia><p id="par0145" class="elsevierStylePara elsevierViewall">In general&#44; patients follow post-dermatologic surgery wound care instructions&#46; However&#44; a significant number of patients&#8212;especially the elderly&#8212;have difficulty understanding them&#44; highlighting the need to explain them adequately and adapt them to their social reality&#46;<a class="elsevierStyleCrossRefs" href="#bib0585"><span class="elsevierStyleSup">53&#44;54</span></a></p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Limitations</span><p id="par0150" class="elsevierStylePara elsevierViewall">This review is limited by being a narrative and not a systematic literature review&#46; The studies included are methodologically heterogeneous&#44; and in many cases&#44; there are no comparative studies across the various agents&#47;procedures&#46; Furthermore&#44; clinical trials on the topic are scarce&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conclusions</span><p id="par0155" class="elsevierStylePara elsevierViewall">There is significant variability in postoperative wound care recommendations in dermatology&#46; The evidence on the superiority of different agents and techniques is&#44; in most cases&#44; limited&#46; However&#44; there is sufficient evidence to discourage the use of prophylactic topical antibiotics&#46; The use of petrolatum or silicone gel offers similar results&#44; with lower complication rates&#46; Although advanced dressings may be more comfortable than conventional ones due to less frequent changes&#44; they are not superior in terms of healing time or incidence of SWI&#46; In SIH&#44; foam dressings appear to be superior to conventional gauze&#46; Prospective comparative studies are needed to provide evidence-based recommendations&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Funding</span><p id="par0160" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicts of interest</span><p id="par0165" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
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        0 => array:3 [
          "identificador" => "xres2262986"
          "titulo" => "Abstract"
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            0 => array:1 [
              "identificador" => "abst0005"
            ]
          ]
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        1 => array:2 [
          "identificador" => "xpalclavsec1889424"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres2262987"
          "titulo" => "Resumen"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0010"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1889425"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Methods"
        ]
        6 => array:3 [
          "identificador" => "sec0015"
          "titulo" => "Results"
          "secciones" => array:6 [
            0 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Moisturizers and topical antibiotics"
            ]
            1 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Start and frequency of care"
            ]
            2 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Dressings"
            ]
            3 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Antiseptics"
            ]
            4 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Negative pressure therapy"
            ]
            5 => array:3 [
              "identificador" => "sec0045"
              "titulo" => "Special situations"
              "secciones" => array:5 [
                0 => array:2 [
                  "identificador" => "sec0050"
                  "titulo" => "Care of surgical wounds with skin grafts"
                ]
                1 => array:2 [
                  "identificador" => "sec0055"
                  "titulo" => "Donor site wounds for skin grafts"
                ]
                2 => array:2 [
                  "identificador" => "sec0060"
                  "titulo" => "Wounds covered with dermal xenografts"
                ]
                3 => array:2 [
                  "identificador" => "sec0065"
                  "titulo" => "Surgical wounds with secondary intention healing"
                ]
                4 => array:2 [
                  "identificador" => "sec0070"
                  "titulo" => "Surgical wounds on the legs"
                ]
              ]
            ]
          ]
        ]
        7 => array:2 [
          "identificador" => "sec0075"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0080"
          "titulo" => "Limitations"
        ]
        9 => array:2 [
          "identificador" => "sec0085"
          "titulo" => "Conclusions"
        ]
        10 => array:2 [
          "identificador" => "sec0090"
          "titulo" => "Funding"
        ]
        11 => array:2 [
          "identificador" => "sec0095"
          "titulo" => "Conflicts of interest"
        ]
        12 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2023-11-27"
    "fechaAceptado" => "2024-05-08"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1889424"
          "palabras" => array:5 [
            0 => "Wound care"
            1 => "Dermatologic surgery"
            2 => "Mohs surgery"
            3 => "Dressings"
            4 => "Grafts"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1889425"
          "palabras" => array:6 [
            0 => "Curas"
            1 => "Herida quir&#250;rgica"
            2 => "Cirug&#237;a dermatol&#243;gica"
            3 => "Cirug&#237;a de Mohs"
            4 => "Ap&#243;sitos"
            5 => "Injertos"
          ]
        ]
      ]
    ]
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    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Dermatologic surgery is associated with a very low risk of complications&#46; There is no widely accepted&#44; evidence-based protocol with recommendations for postoperative wound care after dermatologic surgery&#46; In this narrative review&#44; we will be discussing the evidence on surgical wound care products and procedures&#46; Overall&#44; we found relatively few studies and&#44; in many cases&#44; a lack of statistically significant differences&#44; possibly because of the low rate of complications&#46; We&#8217;ll be discussing the evidence on when we should initiate wound care procedures and their frequency&#44; the type of ointment and antiseptics that should be applied&#44; and the type of dressings that should be used&#46; Despite the very few studies available on postoperative wound care following dermatologic surgery&#44; there is sufficient evidence as to not recommend the use of prophylactic topical antibiotics&#46; We also analyze the currently available evidence on surgical wound care in special situations&#44; such as management of skin grafts&#44; partial skin graft donor sites&#44; xenografts&#47;biomembranes&#44; and surgical wounds to the legs&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La cirug&#237;a dermatol&#243;gica asocia un riesgo de complicaciones muy bajo&#46; No existe un protocolo universalmente aceptado sobre las recomendaciones de curas poscirug&#237;a dermatol&#243;gica&#46; En esta revisi&#243;n narrativa&#44; discutimos la evidencia sobre productos y procedimientos para el cuidado de la herida quir&#250;rgica&#46; En general&#44; encontramos escasos estudios y en muchas ocasiones&#44; falta de diferencias estad&#237;sticamente significativas&#44; posiblemente dada la baja tasa de complicaciones&#46; Discutimos la evidencia sobre cu&#225;ndo iniciar las curas y su frecuencia&#44; el tipo de ung&#252;ento a aplicar&#44; los antis&#233;pticos y el tipo de ap&#243;sito a utilizar&#46; Pese a los escasos estudios sobre las curas tras cirug&#237;a dermatol&#243;gica&#44; existe evidencia suficiente para desaconsejar la utilizaci&#243;n de antibi&#243;ticos t&#243;picos profil&#225;cticos&#46; Tambi&#233;n analizamos la evidencia publicada sobre el cuidado de la herida quir&#250;rgica en situaciones especiales&#44; como son los injertos cut&#225;neos&#44; las zonas dadoras de injertos cut&#225;neos de espesor parcial&#44; los xenoinjertos&#47;biomembranas y las heridas quir&#250;rgicas en las piernas&#46;</p></span>"
      ]
    ]
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        "etiqueta" => "Table 1"
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                  <table border="0" frame="\n
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                  \t\t\t\t">Common phases in wounds<a class="elsevierStyleCrossRef" href="#bib0595"><span class="elsevierStyleSup">55</span></a></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Hemostasis and early inflammation &#40;first 4 to 6 days&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">The damaged blood vessel constricts&#44; and the surrounding endothelium and platelets activate the coagulation cascade&#46; The clot releases cytokines and growth factors that initiate the inflammatory response&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Chemotaxis and macrophage activation &#40;48 to 96 hours&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">The clot recruits neutrophils&#44; which release proteolytic substances to degrade bacteria and excess tissue&#46; The accumulation of inflammatory mediators activates macrophages&#44; which participate in the onset of angiogenesis&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Proliferative phase&#58; re-epithelialization&#44; angiogenesis&#44; and granulation &#40;days 4 to 14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Maturation and remodeling &#40;Day 8 to 1 year&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Epithelialization is initially stimulated by fibroblasts&#44; occurring from the edges of the epithelium toward the center of the wound&#46;Vascular endothelial growth factor &#40;VEGF&#41;&#44; mainly secreted by keratinocytes in response to hypoxia&#44; stimulates the formation of new capillaries&#46;Hypoxia in endothelial cells promotes the secretion of nitric oxide&#44; which causes vasodilation&#46;Fibroblasts migrate to the wound&#44; activate&#44; synthesize collagen&#44; proliferate&#44; and transform into myofibroblasts&#44; which will eventually cause wound contraction&#46;Initially&#44; the matrix is composed mainly of fibrin and fibronectin&#46; Subsequently&#44; fibroblasts synthesize a provisional&#44; disorganized matrix of glycosaminoglycans&#44; proteoglycans&#44; and other proteins&#46;This temporary matrix is eventually replaced by a stronger and more organized collagen matrix&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
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                  \t\t\t\t">Phases associated with skin grafts</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Plasma imbibition phase &#40;first 24 to 48 hours&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">The graft is fixed to the receptor bed&#44; allowing it to absorb exudate and remain hydrated and nourished during the avascular phase&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Inosculation &#40;48 to 72 hours&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Anastomosis between the receptor bed and the dermal vessels of the graft&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Neovascularization and blood flow bridging between graft and bed &#40;up to 4 to 7 days&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Re-epithelialization &#40;From day 4-8 to several weeks later&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Physiological process of wound healing&#46;</p>"
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          "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">RCT&#44; randomized clinical trial&#59; MMS&#44; Mohs micrographic surgery&#59; SWI&#44; surgical would infection&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Author and year&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Study type&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Number of wounds&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Intervention&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Main results&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Smack et al&#46;&#44; 1996<a class="elsevierStyleCrossRef" href="#bib0545"><span class="elsevierStyleSup">45</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RCT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1249 dermatological wounds&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Comparison of petroleum jelly vs bacitracin ointment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- No significant differences in the rates of surgical wound infection &#40;2&#46;0&#37; vs 0&#46;9&#37;&#59; p <span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span> 0&#46;37&#41;&#46; - No significant differences in contact dermatitis rates &#40;0&#37; vs 0&#46;9&#37;&#59; p <span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span> 0&#46;12&#41;&#46; - No significant postoperative differences in healing between treatment groups on day 1 &#40;p <span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span> 0&#46;98&#41;&#44; day 7 &#40;p <span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span> 0&#46;86&#41;&#44; or day 28 &#40;p <span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span> 0&#46;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dixon et al&#46;&#44; 2006<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">46</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RCT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1801 surgical wounds&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Comparison of no ointment before the postoperative dressing vs petroleum jelly vs mupirocin ointment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- No significant differences in infection rates &#40;1&#46;4&#37;&#44; 1&#46;6&#37;&#44; and 2&#46;3&#37;&#44; respectively&#59; p <span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span> 0&#46;490&#41;&#46; - No significant differences in the rates of complications &#40;including the rates of bleeding&#44; scarring&#44; dehiscence&#44; and SWI&#59; 3&#46;5&#37;&#44; 4&#46;7&#37;&#44; and 4&#46;8&#37;&#44; respectively&#59; p <span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span> 0&#46;590&#41;&#46; - No differences in postoperative pain&#44; discomfort level&#44; or overall satisfaction with treatment&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Heal et al&#46;&#44; 2009<a class="elsevierStyleCrossRef" href="#bib0600"><span class="elsevierStyleSup">56</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RCT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">972 minor dermatological surgeries&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Comparison of paraffin vs chloramphenicol ointment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- The incidence of SWI was significantly lower in the chloramphenicol group &#40;6&#46;6&#37;&#41; vs the control one &#40;11&#46;0&#37;&#41; &#40;p <span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span> 0&#46;010&#41;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Taylor et al&#46;&#44; 2011<a class="elsevierStyleCrossRef" href="#bib0555"><span class="elsevierStyleSup">47</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospective split-face study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 patients with 2 facial papulosis nigra lesions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Comparison of repair ointment &#40;Aquaphor&#174;&#41; on one lesion vs antibiotic ointment &#40;polymyxin B&#47;bacitracin&#41; on a different lesion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- No SWI reported&#46; - No observed differences in erythema&#44; edema&#44; re-epithelialization&#44; crusting&#44; hyperpigmentation&#44; irritation&#44; or pain&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Draelos et al&#46;&#44; 2011<a class="elsevierStyleCrossRef" href="#bib0560"><span class="elsevierStyleSup">48</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospective split-face study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 patients with 2 seborrheic keratoses on the trunk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Comparison of repair ointment &#40;Aquaphor&#174;&#41; on one lesion vs antibiotic ointment &#40;polymyxin B&#47;bacitracin&#41; on a different lesion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- No SWI reported&#46; - No differences in erythema&#44; edema&#44; re-epithelialization&#44; or crust formation&#46; - Greater subjective irritation reported in the antibiotic group within the first week&#46; - 1 case of allergic contact dermatitis with antibiotics was reported&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Benedetto et al&#46;&#44; 2021<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">8</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RCT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">231 &#40;67 underwent MMS and 164 various dermatological procedures&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Comparison of silicone gel &#40;Stratamed&#174;&#41; vs a product with 3 topical antibiotics &#40;Neosporin&#174;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- No significant differences in the rates of SWI&#46; - The antibiotic product was associated with 19&#37; contact dermatitis &#40;0&#37; in the silicone group&#41; &#40;p &#60; 0&#46;001&#41;&#46; - Healing time and tissue quality were better with silicone gel&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Prospective studies on the use of topical antibiotics on post-dermatologic procedure wound infection rates&#46;</p>"
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        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
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        "tabla" => array:2 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Type&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Composition&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Characteristics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Indications&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Change frequency&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Film&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Polyurethane or copolyester with acrylic adhesive backing&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Permeable to gas but not to liquid water and bacteria&#46;- Highly moisturizing&#44; no absorbent capacity&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dry wounds&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Few times a week&#44; up to 7 days&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hydrogel&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cross-linked starch polymers in 80&#37; up to 90&#37; water base&#46; Available as fluid gels&#44; flexible sheets&#44; and impregnated gauze&#46;No adhesive backing&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Semi-permeable to gases and fluids&#46; - Highly moisturizing&#46; - Promotes autolytic debridement&#44; granulation&#44; and re-epithelialization&#46; - Limited absorbent capacity&#46; - Reduces temperature by about 5<span class="elsevierStyleHsp" style=""></span>&#176;C&#44; which may decrease pain perception&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Wounds with light exudate or dry wounds&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Every 1 to 3 days&#44; depending on wound hydration&#46;Care is advised to avoid maceration of surrounding skin&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hydrocolloid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hydrophilic and adhesive matrix of polymers such as gelatin and pectin&#44; with an outer layer of polyurethane&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Semi-permeable to water and gas&#44; but impermeable to fluids and bacteria&#46; - Moisturizing&#46; - Promotes autolytic debridement&#44; angiogenesis&#44; granulation&#44; and re-epithelialization&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Wounds with light to moderate exudate&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Initially once a day&#44; then every 3 to 7 days&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Foam&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Opaque polyurethane or sponge-like polymer with a semi-occlusive and hydrophobic backing&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Permeable to gas&#44; but not to liquid water and bacteria&#46; - Highly absorbent&#46; - Provides cushioning and thermal insulation&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Wounds with moderate-to-severe exudate&#46; - Wounds covered by granulation tissue or skin&#46; - Donor site for graft&#46; - Secondary intention wounds&#46;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">From once a day to once or twice a week&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alginate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alginate acid fibers &#40;similar to cellulose but marine-derived&#41; covered with calcium and sodium salts&#46;No adhesive backing&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Highly absorbent&#46; - Not moisturizing&#46; - Sodium ions from exudate are exchanged for calcium from the dressing&#44; forming a hydrophilic gel&#46; - Calcium activates prothrombin and the coagulation cascade&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Highly exudative wounds&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">From week 1 or until the gel loses viscosity&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3679510.png"
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Foam dressings have proven beneficial in surgical wounds healing by secondary intention&#44; in terms of reducing healing time&#44; pain&#44; and nursing interventions vs conventional gauzes&#46;<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">37</span></a></p> <p class="elsevierStyleNotepara" id="npar0010">Source&#58; Axibal and Brown&#46;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">13</span></a></p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Types of advanced dressings&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at4"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mechanism of Action<a class="elsevierStyleCrossRef" href="#bib0605"><span class="elsevierStyleSup">57</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Potential advantages in postoperative wound care<a class="elsevierStyleCrossRef" href="#bib0610"><span class="elsevierStyleSup">58</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Increases capillary flow&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Reduces shear forces&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Promotes granulation tissue&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Restricts seroma and hematoma formation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Decreases bacterial load&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- May increase patient comfort&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Maintains a moist environment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- May reduce epithelialization time&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Removes excess exudate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3679506.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Mechanism of action and potential advantages of negative pressure therapy in postoperative wound care&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0025"
        "etiqueta" => "Table 5"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at5"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Fixation technique&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Material in contact with the graft&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Sutured compression dressing &#40;SCD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Petrolatum-impregnated gauze<a class="elsevierStyleCrossRef" href="#bib0635"><span class="elsevierStyleSup">63</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Continuous reinforcement suture<a class="elsevierStyleCrossRef" href="#bib0615"><span class="elsevierStyleSup">59</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Antibiotic-impregnated gauze or iodine povidone gauze<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">19</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Reinforcement with Telfa&#174; and staples<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">26</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Bismuth tribromophenate-impregnated gauze &#40;XeroformTM&#41;<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">29</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Reinforcement with polyurethane foam<a class="elsevierStyleCrossRefs" href="#bib0620"><span class="elsevierStyleSup">60&#44;61</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Non-adhesive contact dressings &#40;MepitelTM&#41;<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">7&#8211;9</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Unreinforced coverage<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">7&#8211;9</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Foam<a class="elsevierStyleCrossRef" href="#bib0620"><span class="elsevierStyleSup">60</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Mattress sutures<a class="elsevierStyleCrossRef" href="#bib0630"><span class="elsevierStyleSup">62</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Sponges<a class="elsevierStyleCrossRef" href="#bib0620"><span class="elsevierStyleSup">60</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- &#8220;Sandwich&#8221; suture for nasal wing defects<a class="elsevierStyleCrossRef" href="#bib0635"><span class="elsevierStyleSup">63</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab3679509.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Techniques for fixing skin grafts and materials in contact with the graft&#46;</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "tbl0030"
        "etiqueta" => "Table 6"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at6"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Sources&#58; Rosengren et al&#46;<a class="elsevierStyleCrossRef" href="#bib0640"><span class="elsevierStyleSup">64</span></a>&#44; Schlager et al&#46;<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">35</span></a> and Pynn et al&#46;<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">38</span></a>&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Wound characteristics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patient characteristics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Wound location&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Surgical complexity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Bacterial contamination&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Below the knee&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Prolonged duration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Hair around&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Obesity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Groin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Flap creation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Extensive inflammatory skin disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Smoking habit&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Genitals&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Use of grafts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Chronic kidney disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Nose&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Longer scar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Carrier of nasal <span class="elsevierStyleItalic">S&#46; aureus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Ear&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Factors associated with increased risk of surgical wound infection&#46;</p>"
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            "identificador" => "at7"
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">NPT&#44; negative pressure therapy&#46;</p>"
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Recommendation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Level of evidence<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Grade of recommendation<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Avoid prophylactic topical antibiotics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Apply petroleum jelly as a moisturizer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Apply silicone gel as a moisturizer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Wash the wound early 12<span class="elsevierStyleHsp" style=""></span>hours after surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prefer advanced dressings&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Use antiseptics in dressings&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Use NPT on xenografts &#40;biomembranes&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Use hydrocolloid dressings on the graft donor site&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Use non-reinforced coverage on the grafts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Use compression bandages on the legs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Recommendations for managing wounds after dermatological surgery&#46;</p>"
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      "titulo" => "References"
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        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:64 [
            0 => array:3 [
              "identificador" => "bib0325"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Complications in dermatologic surgery&#58; A case-control study exploring factors associated with postsurgical infection and wound dehiscence in a large national group practice"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "T&#46;P&#46; Harding"
                            1 => "N&#46;J&#46; Levin"
                            2 => "J&#46;A&#46; Solomon"
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2022.11.009"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "2023"
                        "volumen" => "88"
                        "paginaInicial" => "930"
                        "paginaFinal" => "932"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36372377"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0330"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Topical antibiotic prophylaxis for prevention of surgical wound infections from dermatologic procedures&#58; A systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; Saco"
                            1 => "N&#46; Howe"
                            2 => "R&#46; Nathoo"
                            3 => "B&#46; Cherpelis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Dermatol Treat"
                        "fecha" => "2015"
                        "volumen" => "26"
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                        "paginaFinal" => "158"
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                ]
              ]
            ]
            2 => array:3 [
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              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of Sterile vs Nonsterile Gloves in Cutaneous Surgery and Common Outpatient Dental Procedures&#58; A Systematic Review and Meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;D&#46; Brewer"
                            1 => "A&#46;B&#46; Gonzalez"
                            2 => "C&#46;L&#46; Baum"
                            3 => "C&#46;J&#46; Arpey"
                            4 => "R&#46;K&#46; Roenigk"
                            5 => "C&#46;C&#46; Otley"
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                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1001/jamadermatol.2016.1965"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA Dermatol"
                        "fecha" => "2016"
                        "volumen" => "152"
                        "paginaInicial" => "1008"
                        "paginaFinal" => "1014"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27487033"
                            "web" => "Medline"
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              "etiqueta" => "4"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Skin Microbiota and its Interplay with Wound Healing"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46; Tomic-Canic"
                            1 => "J&#46;L&#46; Burgess"
                            2 => "K&#46;E&#46; O&#8217;Neill"
                            3 => "N&#46; Strbo"
                            4 => "I&#46; Pastar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s40257-020-00536-w"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Clin Dermatol"
                        "fecha" => "2020"
                        "volumen" => "21"
                        "paginaInicial" => "36"
                        "paginaFinal" => "43"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32914215"
                            "web" => "Medline"
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            4 => array:3 [
              "identificador" => "bib0345"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Variability in Wound Care Recommendations Following Dermatologic Procedures"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;K&#46; Nguyen"
                            1 => "A&#46; Huang"
                            2 => "D&#46;M&#46; Siegel"
                            3 => "J&#46; Jagdeo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/DSS.0000000000001952"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Surg"
                        "fecha" => "2020"
                        "volumen" => "46"
                        "paginaInicial" => "186"
                        "paginaFinal" => "191"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30939523"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0350"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
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Article information

ISSN: 00017310
Original language: English

DOI:10.1016/j.ad.2024.09.014

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