Videos of Surgical Procedures in Dermatology
Rotation Advancement Flap Reconstruction Following Excision of a Squamous Cell Carcinoma in the Infraorbital Malar Region
Reconstrucción de carcinoma espinocelular en región malar infraorbitaria mediante colgajo de rotación-avance
N. Eirís
, G. Pérez Paredes, M.Á. Rodríguez Prieto
Corresponding author
Servicio de Dermatología, Complejo Asistencial Universitario de León, León, Spain
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Eirís, G. Pérez Paredes, M.Á. Rodríguez Prieto" "autores" => array:3 [ 0 => array:4 [ "nombre" => "N." "apellidos" => "Eirís" "email" => array:1 [ 0 => "noemieiris@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "G." "apellidos" => "Pérez Paredes" ] 2 => array:2 [ "nombre" => "M.Á." "apellidos" => "Rodríguez Prieto" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Complejo Asistencial Universitario de León, León, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Reconstrucción de carcinoma espinocelular en región malar infraorbitaria mediante colgajo de rotación-avance" ] ] "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" => 745 "Ancho" => 996 "Tamanyo" => 173701 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Large squamous cell carcinoma in the malar region.</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 cheek region can be divided into 4 areas with different cosmetic properties that must be taken into account during surgical reconstruction: buccal, infraocular or medial, zygomatic or lateral, and mandibular.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2</span></a> Some authors have used the malar prominence, the point of convergence of the borders of these areas, as a reference point. However, the borders between these areas are not clear, depending both on intrinsic factors related to the individual's physionomy and on extrinsic factors associated with photoaging.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In large defects (><span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>cm diameter) affecting the medial area, the most widely used surgical reconstructions use submental or cervicofacial flaps.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,3</span></a> These types of plasty are advanced and rotated during tissue transfer. The flaps, which have a postero-inferior base, have a very rich blood supply derived from the abundant perforating vessels that arise from the transverse and facial arteries.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> Excellent results can also be achieved with island flaps, which take advantage of the abundant subcutaneous adipose tissue of the cheek; or else a combination of the 2 types of flap can be used to achieve adequate skin covering of the defect and avoid tension and secondary ectropion.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> However, the use of grafts is not recommended due to possible retraction and a poorer cosmetic result. The exception is when close monitoring is necessary to detect early recurrence.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The dissection of a cervicofacial flap must be carried out in the subcutaneous plane to preserve the subdermal vascular plexus. The plane deep to the SMAS can be used in thick defects and defects in patients with adverse risk factors for healing (smoking, radiation therapy to the area), though this carries a higher risk of neurovascular injury.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> When the tension vectors of the suture are predominantly vertical, the flap should be fixed to the periostium of the margin of the orbit and to the melonasal sulcus because of the risk of ectropion.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Flap rotation usually gives rise to excess skin that can be eliminated using a Z-plasty or by the excision of Burow triangles, which should be designed in a way to hide scars in the base of a skin fold or crease.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Technique</span><p id="par0020" class="elsevierStylePara elsevierViewall">The patient was a 92-year-old man who was referred to our center for a rapidly growing, poorly defined, ulcerated squamous cell carcinoma of about 3<span class="elsevierStyleHsp" style=""></span>cm diameter affecting the medial malar area and melolabial sulcus (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Given the age of patient and the rapid growth of the lesion, with bleeding and pain, it was decided to perform surgical excision.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">We elected to create a rotation flap (see video). Under general anesthesia, an inferior cheek flap was designed, extending the superior pole of the defect along the natural skinfold of the cheek to the cervical region. The flap was elevated in the subcutaneous plane and was rotated. After confirming good coverage of the defect, the flap was sutured with 4/0 silk. The excess skin was eliminated by 2 small tension-releasing triangles (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Indications</span><p id="par0030" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">•</span><p id="par0035" class="elsevierStylePara elsevierViewall">Large defects (><span class="elsevierStyleHsp" style=""></span>3-4<span class="elsevierStyleHsp" style=""></span>cm diameter) of the malar subunit.</p></li></ul></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Contraindications</span><p id="par0040" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">•</span><p id="par0045" class="elsevierStylePara elsevierViewall">Absolute: none.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">•</span><p id="par0050" class="elsevierStylePara elsevierViewall">Relative: coagulation disorders, extrinsic factors that could predispose to cutaneous ischemia (smoking, previous radiation therapy, etc.), previous surgery to the area that could interfere with flap mobility.</p></li></ul></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Complications</span><p id="par0055" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">•</span><p id="par0060" class="elsevierStylePara elsevierViewall">Surgical wound infection, including skin and deep planes.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">•</span><p id="par0065" class="elsevierStylePara elsevierViewall">Edema, hematoma, and skin necrosis.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">•</span><p id="par0070" class="elsevierStylePara elsevierViewall">Postsurgical ectropion.</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">•</span><p id="par0075" class="elsevierStylePara elsevierViewall">Transient or permanent alterations of sensibility and movement due to injury to nerves, vessels or muscles.</p></li></ul></p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="par0080" class="elsevierStylePara elsevierViewall">The use of a cervicofacial flap for reconstruction of the medial area of the cheek is one of the most useful techniques for the reconstruction of large surgical defects in this area.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> The operation is technically simple, though laborious if extra care is taken to minimize damage to small subjacent blood vessels to reduce postoperative bleeding; when it is necessary to mobilize skin from the cervical region, injury to the neurovascular structures of that region must be avoided.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> The cosmetic and functional results are excellent, as some of the incisions can be hidden in the facial skin folds (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of Interest</span><p id="par0085" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 1 => array:3 [ "identificador" => "sec0010" "titulo" => "Technique" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Indications" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Contraindications" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Complications" ] ] ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Conclusions" ] 3 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of Interest" ] 4 => array:2 [ "identificador" => "xack158208" "titulo" => "Acknowledgments" ] 5 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-08-21" "fechaAceptado" => "2014-12-04" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Eirís N, Pérez Paredes G, Rodríguez Prieto M. Reconstrucción de carcinoma espinocelular en región malar infraorbitaria mediante colgajo de rotación-avance. Actas Dermosifiliogr. 2015;106:319–321.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0100" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0045" ] ] ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 745 "Ancho" => 996 "Tamanyo" => 173701 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Large squamous cell carcinoma in the malar region.</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" => 745 "Ancho" => 996 "Tamanyo" => 153457 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Immediate postoperative appearance; advancement-rotation flap for reconstruction of the surgical defect.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1104 "Ancho" => 995 "Tamanyo" => 237971 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Eight weeks after surgery; the excellent functional and cosmetic result can be seen.</p>" ] ] 3 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc1.mp4" "ficheroTamanyo" => 52015884 "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" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reconstruction of the cheek" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D.T. Bradley" 1 => "C.S. Murakami" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "Local flaps in facial reconstruction" "paginaInicial" => "525" "paginaFinal" => "556" "serieFecha" => "2007" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cirugía reconstructiva de la región cigomática-medial de la mejilla: presentación de 5 casos" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.G. Pérez-Paredes" 1 => "B. González-Sixto" 2 => "M.M. Otero-Rivas" 3 => "M.A. Rodríguez-Prieto" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.adengl.2012.11.029" "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2013" "volumen" => "105" "paginaInicial" => "e27" "paginaFinal" => "e31" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24718266" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reconstruction of cheek defects: A review of current techniques" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "N. Jowett" 1 => "A.M. Mlynarek" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MOO.0b013e32833a6d7f" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Otolaryngol Head Neck Surg" "fecha" => "2010" "volumen" => "18" "paginaInicial" => "244" "paginaFinal" => "254" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20498599" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Local flaps: Cheek and lip reconstruction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.P. Pepper" 1 => "S.R. Baker" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jamafacial.2013.1608" "Revista" => array:6 [ "tituloSerie" => "JAMA Facial Plast Surg" "fecha" => "2013" "volumen" => "15" "paginaInicial" => "374" "paginaFinal" => "382" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24051684" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reconstruction of defects of the infraorbital malar cheek" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E. Rozas-Muñoz" 1 => "R.M. Pujol" 2 => "A. Toll" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1524-4725.2011.02118.x" "Revista" => array:6 [ "tituloSerie" => "Dermatol Surg" "fecha" => "2011" "volumen" => "37" "paginaInicial" => "1675" "paginaFinal" => "1678" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21834932" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack158208" "titulo" => "Acknowledgments" "texto" => "<p id="par0090" class="elsevierStylePara elsevierViewall">To José Lavigne for his help with the production and editing of the video.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010600000004/v2_201505051007/S157821901500058X/v2_201505051007/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/15782190/0000010600000004/v2_201505051007/S157821901500058X/v2_201505051007/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157821901500058X?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 16 | 11 | 27 |
| 2024 October | 82 | 46 | 128 |
| 2024 September | 140 | 45 | 185 |
| 2024 August | 159 | 75 | 234 |
| 2024 July | 113 | 51 | 164 |
| 2024 June | 99 | 37 | 136 |
| 2024 May | 107 | 36 | 143 |
| 2024 April | 83 | 39 | 122 |
| 2024 March | 103 | 35 | 138 |
| 2024 February | 77 | 34 | 111 |
| 2024 January | 62 | 41 | 103 |
| 2023 December | 80 | 29 | 109 |
| 2023 November | 109 | 42 | 151 |
| 2023 October | 91 | 23 | 114 |
| 2023 September | 90 | 42 | 132 |
| 2023 August | 57 | 27 | 84 |
| 2023 July | 108 | 62 | 170 |
| 2023 June | 63 | 40 | 103 |
| 2023 May | 124 | 34 | 158 |
| 2023 April | 57 | 30 | 87 |
| 2023 March | 77 | 29 | 106 |
| 2023 February | 54 | 36 | 90 |
| 2023 January | 54 | 34 | 88 |
| 2022 December | 65 | 37 | 102 |
| 2022 November | 45 | 29 | 74 |
| 2022 October | 31 | 30 | 61 |
| 2022 September | 32 | 60 | 92 |
| 2022 August | 41 | 46 | 87 |
| 2022 July | 41 | 35 | 76 |
| 2022 June | 37 | 36 | 73 |
| 2022 May | 68 | 52 | 120 |
| 2022 April | 62 | 48 | 110 |
| 2022 March | 73 | 49 | 122 |
| 2022 February | 62 | 43 | 105 |
| 2022 January | 70 | 60 | 130 |
| 2021 December | 52 | 41 | 93 |
| 2021 November | 70 | 58 | 128 |
| 2021 October | 76 | 77 | 153 |
| 2021 September | 44 | 39 | 83 |
| 2021 August | 70 | 36 | 106 |
| 2021 July | 57 | 52 | 109 |
| 2021 June | 109 | 48 | 157 |
| 2021 May | 46 | 47 | 93 |
| 2021 April | 175 | 108 | 283 |
| 2021 March | 108 | 36 | 144 |
| 2021 February | 71 | 37 | 108 |
| 2021 January | 62 | 30 | 92 |
| 2020 December | 53 | 25 | 78 |
| 2020 November | 34 | 26 | 60 |
| 2020 October | 33 | 13 | 46 |
| 2020 September | 66 | 14 | 80 |
| 2020 August | 37 | 18 | 55 |
| 2020 July | 23 | 18 | 41 |
| 2020 June | 40 | 31 | 71 |
| 2020 May | 35 | 27 | 62 |
| 2020 April | 34 | 24 | 58 |
| 2020 March | 25 | 20 | 45 |
| 2020 February | 5 | 9 | 14 |
| 2020 January | 4 | 11 | 15 |
| 2019 December | 6 | 7 | 13 |
| 2019 November | 4 | 3 | 7 |
| 2019 October | 0 | 7 | 7 |
| 2019 September | 6 | 6 | 12 |
| 2019 August | 4 | 10 | 14 |
| 2019 July | 4 | 23 | 27 |
| 2019 June | 5 | 21 | 26 |
| 2019 May | 4 | 34 | 38 |
| 2019 April | 2 | 40 | 42 |
| 2019 March | 1 | 11 | 12 |
| 2019 February | 3 | 3 | 6 |
| 2019 January | 3 | 3 | 6 |
| 2018 December | 0 | 3 | 3 |
| 2018 November | 23 | 5 | 28 |
| 2018 October | 3 | 0 | 3 |
| 2018 September | 4 | 1 | 5 |
| 2018 August | 0 | 8 | 8 |
| 2018 July | 0 | 5 | 5 |
| 2018 June | 0 | 4 | 4 |
| 2018 May | 0 | 3 | 3 |
| 2018 April | 0 | 7 | 7 |
| 2018 March | 0 | 5 | 5 |
| 2018 February | 53 | 6 | 59 |
| 2018 January | 30 | 7 | 37 |
| 2017 December | 62 | 10 | 72 |
| 2017 November | 25 | 13 | 38 |
| 2017 October | 22 | 9 | 31 |
| 2017 September | 14 | 8 | 22 |
| 2017 August | 10 | 28 | 38 |
| 2017 July | 19 | 19 | 38 |
| 2017 June | 24 | 35 | 59 |
| 2017 May | 32 | 21 | 53 |
| 2017 April | 14 | 26 | 40 |
| 2017 March | 13 | 12 | 25 |
| 2017 February | 14 | 14 | 28 |
| 2017 January | 17 | 17 | 34 |
| 2016 December | 25 | 16 | 41 |
| 2016 November | 44 | 17 | 61 |
| 2016 October | 34 | 12 | 46 |
| 2016 September | 0 | 19 | 19 |
| 2016 August | 0 | 5 | 5 |
| 2016 July | 5 | 3 | 8 |
| 2016 June | 8 | 4 | 12 |
| 2016 May | 11 | 12 | 23 |
| 2016 April | 6 | 13 | 19 |
| 2016 March | 7 | 10 | 17 |
| 2016 February | 11 | 14 | 25 |
| 2016 January | 12 | 15 | 27 |
| 2015 December | 13 | 9 | 22 |
| 2015 November | 8 | 16 | 24 |
| 2015 October | 1 | 10 | 11 |
| 2015 September | 0 | 2 | 2 |
| 2015 August | 0 | 1 | 1 |
| 2015 July | 5 | 3 | 8 |
| 2015 June | 3 | 2 | 5 |
| 2015 May | 5 | 6 | 11 |
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