Videos of Surgical Procedures in Dermatology
Myochondromucosal Rotation Flap Combined With a Melolabial Trasposition Flap for the Reconstruction of Full-Thickness Defects of the Ala Nasi
Colgajo mio-condro-mucoso de rotación combinado con colgajo de trasposición melolabial para la reconstrucción de defectos de espesor total del ala nasal
L.M. Valladares-Narganes
, B. González-Sixto, M. Otero-Rivas, M.Á. Rodríguez-Prieto
Corresponding author
Servicio de Dermatología, Complejo Asistencial Universitario de León, León, España
Read
9678
Timeswas read the article
2502
Total PDF
7176
Total HTML
Share statistics
array:24 [ "pii" => "S157821901300214X" "issn" => "15782190" "doi" => "10.1016/j.adengl.2013.04.017" "estado" => "S300" "fechaPublicacion" => "2013-11-01" "aid" => "838" "copyright" => "Elsevier España, S.L. and AEDV" "copyrightAnyo" => "2013" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2013;104:821-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4581 "formatos" => array:3 [ "EPUB" => 45 "HTML" => 3875 "PDF" => 661 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0001731013001555" "issn" => "00017310" "doi" => "10.1016/j.ad.2013.04.002" "estado" => "S300" "fechaPublicacion" => "2013-11-01" "aid" => "838" "copyright" => "Elsevier España, S.L. and AEDV" "documento" => "article" "crossmark" => 0 "subdocumento" => "sco" "cita" => "Actas Dermosifiliogr. 2013;104:821-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3459 "formatos" => array:3 [ "EPUB" => 3 "HTML" => 2627 "PDF" => 829 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Vídeos de cirugía dermatológica</span>" "titulo" => "Colgajo mio-condro-mucoso de rotación combinado con colgajo de trasposición melolabial para la reconstrucción de defectos de espesor total del ala nasal" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "821" "paginaFinal" => "823" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Myochondromucosal Rotation Flap Combined With a Melolabial Transposition Flap for the Reconstruction of Full-Thickness Defects of the Ala Nasi" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 858 "Ancho" => 1300 "Tamanyo" => 150233 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A y B. Carcinoma basocelular recidivado en el ala nasal y defecto quirúrgico resultante tras 2 etapas de cirugía de Mohs con esquema de la rotación del colgajo mio-condro-mucoso del ala adyacente.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L.M. Valladares-Narganes, B. González-Sixto, M. Otero-Rivas, M.Á. Rodríguez-Prieto" "autores" => array:4 [ 0 => array:2 [ "nombre" => "L.M." "apellidos" => "Valladares-Narganes" ] 1 => array:2 [ "nombre" => "B." "apellidos" => "González-Sixto" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Otero-Rivas" ] 3 => array:2 [ "nombre" => "M.Á." "apellidos" => "Rodríguez-Prieto" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S157821901300214X" "doi" => "10.1016/j.adengl.2013.04.017" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157821901300214X?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731013001555?idApp=UINPBA000044" "url" => "/00017310/0000010400000009/v1_201310240057/S0001731013001555/v1_201310240057/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1578219013002151" "issn" => "15782190" "doi" => "10.1016/j.adengl.2012.07.036" "estado" => "S300" "fechaPublicacion" => "2013-11-01" "aid" => "729" "copyright" => "Elsevier España, S.L. and AEDV" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2013;104:824-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 6247 "formatos" => array:3 [ "EPUB" => 35 "HTML" => 5350 "PDF" => 862 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Progressive Cribriform and Zosteriform Hyperpigmentation" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "824" "paginaFinal" => "826" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hiperpigmentación zosteriforme y cribiforme progresiva" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 781 "Ancho" => 900 "Tamanyo" => 111523 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Macular lesions of even brown color with a reticulate pattern on normal skin, on the right side of the back, without crossing the midline.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "B. Monteagudo, Á. León-Mateos, F. Campo-Cerecedo, M. Cabanillas" "autores" => array:4 [ 0 => array:2 [ "nombre" => "B." "apellidos" => "Monteagudo" ] 1 => array:2 [ "nombre" => "Á." "apellidos" => "León-Mateos" ] 2 => array:2 [ "nombre" => "F." "apellidos" => "Campo-Cerecedo" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Cabanillas" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731012004462" "doi" => "10.1016/j.ad.2012.07.022" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731012004462?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219013002151?idApp=UINPBA000044" "url" => "/15782190/0000010400000009/v1_201310240051/S1578219013002151/v1_201310240051/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1578219013002138" "issn" => "15782190" "doi" => "10.1016/j.adengl.2013.04.016" "estado" => "S300" "fechaPublicacion" => "2013-11-01" "aid" => "851" "copyright" => "Elsevier España, S.L. and AEDV" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2013;104:819-20" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3028 "formatos" => array:3 [ "EPUB" => 40 "HTML" => 2361 "PDF" => 627 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case for Diagnosis</span>" "titulo" => "Filiform Palmoplantar Papules" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "819" "paginaFinal" => "820" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pápulas filiformes palmoplantares" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 708 "Ancho" => 788 "Tamanyo" => 90335 ] ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Hiraldo-Gamero, J. Gordillo Chaves" "autores" => array:2 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Hiraldo-Gamero" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Gordillo Chaves" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731013002093" "doi" => "10.1016/j.ad.2013.04.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731013002093?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219013002138?idApp=UINPBA000044" "url" => "/15782190/0000010400000009/v1_201310240051/S1578219013002138/v1_201310240051/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Videos of Surgical Procedures in Dermatology</span>" "titulo" => "Myochondromucosal Rotation Flap Combined With a Melolabial Trasposition Flap for the Reconstruction of Full-Thickness Defects of the Ala Nasi" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "821" "paginaFinal" => "823" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "L.M. Valladares-Narganes, B. González-Sixto, M. Otero-Rivas, M.Á. Rodríguez-Prieto" "autores" => array:4 [ 0 => array:4 [ "nombre" => "L.M." "apellidos" => "Valladares-Narganes" "email" => array:2 [ 0 => "lmvalladares84@hotmail.com" 1 => "bigpoe84@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "B." "apellidos" => "González-Sixto" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Otero-Rivas" ] 3 => array:2 [ "nombre" => "M.Á." "apellidos" => "Rodríguez-Prieto" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Complejo Asistencial Universitario de León, León, España" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Colgajo mio-condro-mucoso de rotación combinado con colgajo de trasposición melolabial para la reconstrucción de defectos de espesor total del ala nasal" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 684 "Ancho" => 1300 "Tamanyo" => 123453 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Result 8 weeks after the surgical intervention.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The lateral walls and alae of the nose are cosmetic and functional units of the external nose and are areas where malignant skin tumors, particularly basal cell carcinoma, are common. During reconstruction of this region, we must take into account not only the function of the nares, avoiding retraction, which would lead to collapse during inhalation, but also their symmetry, aiming to achieve the best possible cosmetic result.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The problem is greater if there is a full thickness surgical defect affecting all the tissue planes (mucosa, cartilage, muscle, and skin), as this will considerably reduce the options for reconstruction.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Local intranasal flaps with re-epithelization of the secondary defect are very useful for repair of the mucosal plane, but the technique is laborious. Mucoperichondrial flaps from the nasal septum, wall, or conchae have the added advantage of providing cartilaginous support.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> Cartilage grafts from the septum, helix, or costal cartilage, combined with local flaps are an excellent option.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Finally, the use of inert alloplastic materials, such as titanium or polyethylene mesh, can be a good alternative, particularly in large defects, but none of these materials is free of risks such as necrosis, infection, or extrusion.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In the case presented, after considering all possible options, and in an attempt to minimize their aforementioned drawbacks, we decided to use a myochondromucosal rotation flap from the adjacent ala combined with an ipsilateral melolabial flap. The procedure can be seen in the video.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Technique</span><p id="par0025" class="elsevierStylePara elsevierViewall">The patient was a 79-year-old woman in whom a recurrent basal cell carcinoma was fully excised after 2 stages of Mohs micrographic surgery (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> A). The lesion infiltrated the lateral wall of the nose and a large part of the ala, with full-thickness involvement of the central part of the ala (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> B). The size of the overall defect created was 2<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>cm; the central full-thickness defect measured 1<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>1.2<span class="elsevierStyleHsp" style=""></span>cm. Closure was performed using a myochondromucosal rotation flap from the whole of the adjacent ala combined with an ipsilateral melolabial flap.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">When creating the myochondromucosal flap, we had to ensure that there was an adequate pedicle to avoid necrosis. After rotation onto the area of the tip of the nose, the borders were fixed with an absorbable 4/0 polyglycolic acid suture.</p><p id="par0035" class="elsevierStylePara elsevierViewall">When creating the skin flap, we had to consider not only the length to width ratio, in order to avoid necrosis, but also its thickness, in order to achieve an acceptable cosmetic result and avoid the very undesirable trap-door effect. After resection and adjustment, the tip of the skin flap was sutured with 4/0 silk.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The functional and cosmetic result 8 weeks after the operation was excellent (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Indications</span><p id="par0045" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0050" class="elsevierStylePara elsevierViewall">Reconstruction of partial, full-thickness defects of 1 to 1.5<span class="elsevierStyleHsp" style=""></span>cm in diameter affecting the alar and perialar regions of the nose.</p></li></ul></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">1</span><span class="elsevierStyleSectionTitle" id="sect0020">Contraindications</span><p id="par0055" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0060" class="elsevierStylePara elsevierViewall">Very small full-thickness defects in which cartilage repair is not necessary or when the defect can be closed by direct suture.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0065" class="elsevierStylePara elsevierViewall">Very large defects in which there is insufficient adjacent tissue to cover the defect.</p></li></ul></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">2</span><span class="elsevierStyleSectionTitle" id="sect0025">Risks</span><p id="par0070" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0075" class="elsevierStylePara elsevierViewall">Infection.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0080" class="elsevierStylePara elsevierViewall">Postoperative chondritis.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">-</span><p id="par0085" class="elsevierStylePara elsevierViewall">Trap-door effect.</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">-</span><p id="par0090" class="elsevierStylePara elsevierViewall">Retraction of the ala.</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">-</span><p id="par0095" class="elsevierStylePara elsevierViewall">Unsightly scarring.</p></li></ul></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Alternatives</span><p id="par0100" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">-</span><p id="par0105" class="elsevierStylePara elsevierViewall">Free cartilage grafts from the ear, nasal septum, or ribs; these are more laborious techniques with a high risk of necrosis.</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">-</span><p id="par0110" class="elsevierStylePara elsevierViewall">Alloplastic materials (titanium or polyethylene mesh). Experience is necessary with these materials. There is a risk of infection, extrusion of the material, or a trap-door effect, which would require reoperation.</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">-</span><p id="par0115" class="elsevierStylePara elsevierViewall">Inverted melolabial flap; this does not provide cartilage support.</p></li></ul></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">3</span><span class="elsevierStyleSectionTitle" id="sect0035">Conclusions</span><p id="par0120" class="elsevierStylePara elsevierViewall">Although chondromucosal flaps from the adjacent ala and the melolabial flap are extensively described in the literature, the combination of the 2 flaps has not previously been reported.</p><p id="par0125" class="elsevierStylePara elsevierViewall">We present this combined flap as an excellent option for the reconstruction of partial, full-thickness defects of the alar and perialar regions of the nose. This method of reconstruction offers cartilaginous support without the need for alloplastic materials and with a lower risk of necrosis than other options. This simple and original technique is performed in a single operation under local anesthesia and will stimulate the creative capacity of the dermatologic surgeon.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Technique" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Indications" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Contraindications" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Risks" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Alternatives" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Conclusions" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Valladares-Narganes L, González-Sixto B, Otero-Rivas M, Rodríguez-Prieto M. Colgajo mio-condro-mucoso de rotación combinado con colgajo de trasposición melo. Actas Dermosifiliogr. 2013;104:821–823.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0135" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0045" ] ] ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 858 "Ancho" => 1300 "Tamanyo" => 144581 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A and B, Recurrent basal cell carcinoma of the left nasal ala and the surgical defect left after 2 stages of Mohs micrographic surgery. The diagram shows the rotation of the myochondromucosal flap from the adjacent ala.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 684 "Ancho" => 1300 "Tamanyo" => 123453 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Result 8 weeks after the surgical intervention.</p>" ] ] 2 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc1.mp4" "ficheroTamanyo" => 82940460 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc1.flv" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:2 [ "fichero" => "mmc1.m4v" "poster" => "mmc1.jpg" ] ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Repair of full-thickness nasal alar defect" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A.M. Skaria" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Dermatol Surg" "fecha" => "2003" "volumen" => "29" "paginaInicial" => "89" "paginaFinal" => "91" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12534519" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nasal reconstruction based on subunit principle combined with turn over island nasal skin flap for nasal lining restoration" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "B.T. Ulug" 1 => "I. Kuran" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/SAP.0b013e31816d8214" "Revista" => array:6 [ "tituloSerie" => "Ann Plast Surg" "fecha" => "2008" "volumen" => "61" "paginaInicial" => "521" "paginaFinal" => "526" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18948779" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nasal reconstruction utilizing a muscle hinge flap with overlying full-thickness skin graft" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D.J. Fader" 1 => "T.S. Wang" 2 => "T.M. Johnson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1067/mjd.2000.108374" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2000" "volumen" => "43" "paginaInicial" => "837" "paginaFinal" => "840" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11050590" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Repair of full-thickness alar defects" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C. Qian" 1 => "X. Yaodong" 2 => "H. Xiaoming" 3 => "F. Shaochong" 4 => "Z. Yiqing" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1524-4725.2012.02494.x" "Revista" => array:6 [ "tituloSerie" => "Dermatol Surg" "fecha" => "2012" "volumen" => "38" "paginaInicial" => "1639" "paginaFinal" => "1644" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22712576" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Partial nasal reconstruction with titanium mesh: Report of five cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.A. Rodriguez-Prieto" 1 => "A. Perez-Bustillo" 2 => "T. Alonso-Alonso" 3 => "P. Sanchez-Sambucety" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2133.2009.09257.x" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2009" "volumen" => "161" "paginaInicial" => "683" "paginaFinal" => "687" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19545299" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010400000009/v1_201310240051/S157821901300214X/v1_201310240051/en/main.assets" "Apartado" => array:4 [ "identificador" => "6209" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Videos of Surgical Procedures in Dermatology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010400000009/v1_201310240051/S157821901300214X/v1_201310240051/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157821901300214X?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 11 | 6 | 17 |
| 2024 October | 67 | 36 | 103 |
| 2024 September | 69 | 33 | 102 |
| 2024 August | 120 | 55 | 175 |
| 2024 July | 119 | 47 | 166 |
| 2024 June | 116 | 40 | 156 |
| 2024 May | 96 | 36 | 132 |
| 2024 April | 77 | 23 | 100 |
| 2024 March | 101 | 28 | 129 |
| 2024 February | 79 | 29 | 108 |
| 2024 January | 65 | 33 | 98 |
| 2023 December | 74 | 24 | 98 |
| 2023 November | 60 | 26 | 86 |
| 2023 October | 97 | 33 | 130 |
| 2023 September | 101 | 37 | 138 |
| 2023 August | 59 | 37 | 96 |
| 2023 July | 96 | 35 | 131 |
| 2023 June | 91 | 23 | 114 |
| 2023 May | 72 | 34 | 106 |
| 2023 April | 62 | 25 | 87 |
| 2023 March | 67 | 29 | 96 |
| 2023 February | 87 | 27 | 114 |
| 2023 January | 50 | 36 | 86 |
| 2022 December | 73 | 46 | 119 |
| 2022 November | 38 | 32 | 70 |
| 2022 October | 36 | 28 | 64 |
| 2022 September | 30 | 37 | 67 |
| 2022 August | 28 | 42 | 70 |
| 2022 July | 25 | 34 | 59 |
| 2022 June | 22 | 25 | 47 |
| 2022 May | 47 | 45 | 92 |
| 2022 April | 45 | 35 | 80 |
| 2022 March | 50 | 54 | 104 |
| 2022 February | 53 | 29 | 82 |
| 2022 January | 62 | 35 | 97 |
| 2021 December | 53 | 41 | 94 |
| 2021 November | 49 | 49 | 98 |
| 2021 October | 54 | 46 | 100 |
| 2021 September | 45 | 37 | 82 |
| 2021 August | 36 | 37 | 73 |
| 2021 July | 53 | 38 | 91 |
| 2021 June | 53 | 46 | 99 |
| 2021 May | 53 | 44 | 97 |
| 2021 April | 71 | 59 | 130 |
| 2021 March | 65 | 48 | 113 |
| 2021 February | 47 | 19 | 66 |
| 2021 January | 31 | 17 | 48 |
| 2020 December | 33 | 12 | 45 |
| 2020 November | 30 | 18 | 48 |
| 2020 October | 35 | 10 | 45 |
| 2020 September | 41 | 13 | 54 |
| 2020 August | 23 | 19 | 42 |
| 2020 July | 29 | 20 | 49 |
| 2020 June | 40 | 25 | 65 |
| 2020 May | 30 | 25 | 55 |
| 2020 April | 44 | 21 | 65 |
| 2020 March | 35 | 22 | 57 |
| 2020 February | 8 | 1 | 9 |
| 2020 January | 6 | 5 | 11 |
| 2019 December | 8 | 4 | 12 |
| 2019 November | 4 | 3 | 7 |
| 2019 October | 0 | 2 | 2 |
| 2019 September | 4 | 4 | 8 |
| 2019 August | 4 | 6 | 10 |
| 2019 July | 4 | 6 | 10 |
| 2019 June | 6 | 18 | 24 |
| 2019 May | 4 | 27 | 31 |
| 2019 April | 2 | 13 | 15 |
| 2019 March | 4 | 7 | 11 |
| 2019 February | 2 | 1 | 3 |
| 2019 January | 5 | 2 | 7 |
| 2018 December | 0 | 7 | 7 |
| 2018 October | 4 | 0 | 4 |
| 2018 September | 4 | 0 | 4 |
| 2018 July | 0 | 2 | 2 |
| 2018 June | 0 | 1 | 1 |
| 2018 March | 19 | 3 | 22 |
| 2018 February | 114 | 5 | 119 |
| 2018 January | 150 | 8 | 158 |
| 2017 December | 89 | 8 | 97 |
| 2017 November | 90 | 5 | 95 |
| 2017 October | 96 | 11 | 107 |
| 2017 September | 70 | 13 | 83 |
| 2017 August | 83 | 9 | 92 |
| 2017 July | 78 | 10 | 88 |
| 2017 June | 81 | 15 | 96 |
| 2017 May | 76 | 6 | 82 |
| 2017 April | 86 | 11 | 97 |
| 2017 March | 66 | 21 | 87 |
| 2017 February | 61 | 14 | 75 |
| 2017 January | 64 | 20 | 84 |
| 2016 December | 95 | 13 | 108 |
| 2016 November | 139 | 19 | 158 |
| 2016 October | 166 | 16 | 182 |
| 2016 September | 235 | 17 | 252 |
| 2016 August | 212 | 2 | 214 |
| 2016 July | 98 | 6 | 104 |
| 2016 June | 7 | 7 | 14 |
| 2016 May | 13 | 5 | 18 |
| 2016 April | 5 | 15 | 20 |
| 2016 March | 4 | 1 | 5 |
| 2016 February | 14 | 23 | 37 |
| 2016 January | 14 | 18 | 32 |
| 2015 December | 10 | 22 | 32 |
| 2015 November | 14 | 20 | 34 |
| 2015 October | 4 | 1 | 5 |
| 2015 September | 10 | 1 | 11 |
| 2015 August | 6 | 5 | 11 |
| 2015 July | 172 | 7 | 179 |
| 2015 June | 96 | 13 | 109 |
| 2015 May | 99 | 17 | 116 |
| 2015 April | 72 | 10 | 82 |
| 2015 March | 100 | 16 | 116 |
| 2015 February | 126 | 6 | 132 |
| 2015 January | 84 | 7 | 91 |
| 2014 December | 77 | 8 | 85 |
| 2014 November | 65 | 10 | 75 |
| 2014 October | 77 | 14 | 91 |
| 2014 September | 55 | 15 | 70 |
| 2014 August | 68 | 9 | 77 |
| 2014 July | 65 | 7 | 72 |
| 2014 June | 65 | 10 | 75 |
| 2014 May | 69 | 8 | 77 |
| 2014 April | 55 | 9 | 64 |
| 2014 March | 53 | 8 | 61 |
| 2014 February | 59 | 8 | 67 |
| 2014 January | 32 | 10 | 42 |
| 2013 December | 37 | 4 | 41 |
| 2013 November | 15 | 7 | 22 |
| 2013 October | 2 | 0 | 2 |
Show all
