Case and Research Letters
Use of the Burow Triangle or Wedge-shaped Resection During the Repair of Infraorbital Defects
Uso del triángulo de Burow o escisión en «V» para la reparación de defectos infraorbitarios
L.M. Molinari
, D. Ferrario, G.N. Galimberti
Corresponding author
Centro de Cáncer de piel y Cirugía Micrográfica de Mohs, Servicio de Dermatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Molinari, D. Ferrario, G.N. Galimberti" "autores" => array:3 [ 0 => array:4 [ "nombre" => "L.M." "apellidos" => "Molinari" "email" => array:1 [ 0 => "leisa.molinari@hospitalitaliano.org.ar" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "D." "apellidos" => "Ferrario" ] 2 => array:2 [ "nombre" => "G.N." "apellidos" => "Galimberti" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Centro de Cáncer de piel y Cirugía Micrográfica de Mohs, Servicio de Dermatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Uso del triángulo de Burow o escisión en «V» para la reparación de defectos infraorbitarios" ] ] "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" => 1151 "Ancho" => 1150 "Tamanyo" => 241338 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Case 1. Surgical resection of a malignant tumor leaving a defect in the infraorbital region. Closure using a Burow triangle or wedge-shaped resection.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Facial reconstruction surgery requires detailed knowledge of anatomic and functional structures such as the nose, eyelids, and lips, because of the importance of preserving their function, shape, and cosmetic appearance.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Various surgical techniques are available to repair defects; the quickest and simplest reconstruction is by direct closure. First, an ellipse must be created; this involves lengthening the surgical incision to eliminate the excess skin at each end of the incision. One technique used to remove excess skin is the Burow triangle or wedge-shaped resection.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The lower eyelid is formed by the orbicularis muscle covered by thin and lax skin. The infraorbital region is the area immediately inferior and medial to the lower eyelid, and the malar region is inferior and lateral to this eyelid; lower down these 2 regions give rise to the cheek. These facial cosmetic areas have different textures, colors, and densities, from a fine skin with minimal subcutaneous cellular tissue in the eyelid to the thicker skin of the cheek, strongly adherent to the subcutaneous cellular tissue.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In the repair of defects that affect the infraorbital or malar regions, the skin of the cheek is united with the skin of the eyelid, despite these marked differences, and there is the associated risk of provoking eversion of the palpebral margin, separating it from the surface of the eye and producing ectropion.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">We present a simple option for closure that minimizes this possibility.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Surgical Technique</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">First Step: Design</span><p id="par0030" class="elsevierStylePara elsevierViewall">The elliptical excision must be marked before performing anesthesia because the anesthetic injection will distort the anatomy. A Burow triangle is then designed at the medial end (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Second Step: Incision and Dissection of the Skin</span><p id="par0040" class="elsevierStylePara elsevierViewall">It is important to dissect the tissues in the direction of the cheek to achieve better displacement. Do not dissect towards the eyelid because of the fragility of the skin in that area.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Third Step: Anchorage</span><p id="par0045" class="elsevierStylePara elsevierViewall">The first stitch must be placed at the point of greatest tension, which is between points a and a’ shown in <a class="elsevierStyleCrossRef" href="#fig0005">figure 1</a> B, C, and D. This is performed with a nonabsorbable intradermal suture.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Fourth Step: External Sutures</span><p id="par0055" class="elsevierStylePara elsevierViewall">We prefer to use horizontal U stitches buried in the lower eyelid.</p><p id="par0060" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRefs" href="#fig0010">Figures 2 and 3</a> show patients in whom malignant tumors were excised. Closure of the defect was performed using the technique described.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Important Points</span><p id="par0065" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0070" class="elsevierStylePara elsevierViewall">It is essential to make the first stitch a to a’ in a diagonal orientation (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B) to prevent tension perpendicular to free border of the eyelid, which would provoke ectropion.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0075" class="elsevierStylePara elsevierViewall">Protect the skin of the lower eyelid, as it is thin and delicate.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3.</span><p id="par0080" class="elsevierStylePara elsevierViewall">The intradermal suture can cause ectropion if fibers of the orbicularis muscle are included in the suture.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a></p></li></ul></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclusion</span><p id="par0085" class="elsevierStylePara elsevierViewall">We have proposed this technique for infraorbital defects of up to 1<span class="elsevierStyleHsp" style=""></span>cm diameter. In a previous article we described a rotation-advancement flap for larger defects.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">The use of the Burow triangle in the ellipse is not only to remove excess skin, but also to move the point of greatest tension, transferring it to the medial sector of the eyelid, which will minimize the risk of ectropion (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>, C and D).</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:3 [ "identificador" => "sec0005" "titulo" => "Surgical Technique" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "First Step: Design" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Second Step: Incision and Dissection of the Skin" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Third Step: Anchorage" ] 3 => array:2 [ "identificador" => "sec0025" "titulo" => "Fourth Step: External Sutures" ] ] ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Important Points" ] 2 => array:2 [ "identificador" => "sec0035" "titulo" => "Conclusion" ] 3 => 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: Molinari LM, Ferrario D, Galimberti GN. Use of the Burow Triangle or Wedge-shaped Resection During the Repair of Infraorbital Defects. Actas Dermosifiliogr. 2015;106:689–691.</p>" ] ] "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" => 1150 "Ancho" => 1150 "Tamanyo" => 112370 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Design of the closure; the Burow triangle is designed at the medial end of the incision. B, Anchorage of the ellipse; a to a’ orientation of the first stitch. C, Diagonal movement of the skin. D, Final closure. The points indicate the area of greatest tension when the borders are united.</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" => 1151 "Ancho" => 1150 "Tamanyo" => 241338 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Case 1. Surgical resection of a malignant tumor leaving a defect in the infraorbital region. Closure using a Burow triangle or wedge-shaped resection.</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" => 1300 "Ancho" => 1300 "Tamanyo" => 326359 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Case 2. Surgical resection of a malignant tumor leaving a defect in the infraorbital region. Closure using a Burow triangle or wedge-shaped resection.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Colgajos de avance con triángulo de Burow en la cara" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Pérez Santos" 1 => "R. Marengo Otero" 2 => "M.J. González-Beato Merino" 3 => "P. García Morrás" 4 => "C. Bueno Marco" 5 => "P. 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Prada" 2 => "M.A. Rodríguez-Prieto" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ad.2010.07.005" "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2011" "volumen" => "102" "paginaInicial" => "167" "paginaFinal" => "174" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21353190" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0035" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The eye and eyelid" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.K. Robinson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:5 [ "titulo" => "Roenigk's dermatologic surgery" "paginaInicial" => "210" "paginaFinal" => "215" "edicion" => "3rd ed" "serieFecha" => "2007" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0040" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Utilidade do retalho de avanço e rotação para fechamento de defeitos cutâneos na região malar" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "G. Galimberti" 1 => "D. Ferrario" 2 => "G. Riveiro Casabona" 3 => "L.M. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 71 | 7 | 78 |
| 2024 October | 697 | 48 | 745 |
| 2024 September | 517 | 32 | 549 |
| 2024 August | 484 | 57 | 541 |
| 2024 July | 422 | 28 | 450 |
| 2024 June | 364 | 41 | 405 |
| 2024 May | 271 | 36 | 307 |
| 2024 April | 277 | 27 | 304 |
| 2024 March | 289 | 34 | 323 |
| 2024 February | 284 | 43 | 327 |
| 2024 January | 519 | 47 | 566 |
| 2023 December | 448 | 32 | 480 |
| 2023 November | 392 | 36 | 428 |
| 2023 October | 306 | 30 | 336 |
| 2023 September | 270 | 33 | 303 |
| 2023 August | 237 | 21 | 258 |
| 2023 July | 191 | 46 | 237 |
| 2023 June | 219 | 29 | 248 |
| 2023 May | 242 | 31 | 273 |
| 2023 April | 152 | 30 | 182 |
| 2023 March | 187 | 23 | 210 |
| 2023 February | 247 | 21 | 268 |
| 2023 January | 154 | 30 | 184 |
| 2022 December | 121 | 45 | 166 |
| 2022 November | 68 | 25 | 93 |
| 2022 October | 41 | 30 | 71 |
| 2022 September | 48 | 43 | 91 |
| 2022 August | 19 | 32 | 51 |
| 2022 July | 39 | 41 | 80 |
| 2022 June | 17 | 21 | 38 |
| 2022 May | 103 | 54 | 157 |
| 2022 April | 176 | 48 | 224 |
| 2022 March | 161 | 73 | 234 |
| 2022 February | 173 | 25 | 198 |
| 2022 January | 224 | 48 | 272 |
| 2021 December | 138 | 46 | 184 |
| 2021 November | 163 | 47 | 210 |
| 2021 October | 111 | 59 | 170 |
| 2021 September | 95 | 77 | 172 |
| 2021 August | 131 | 34 | 165 |
| 2021 July | 98 | 36 | 134 |
| 2021 June | 124 | 27 | 151 |
| 2021 May | 106 | 33 | 139 |
| 2021 April | 204 | 59 | 263 |
| 2021 March | 152 | 29 | 181 |
| 2021 February | 113 | 36 | 149 |
| 2021 January | 62 | 17 | 79 |
| 2020 December | 63 | 19 | 82 |
| 2020 November | 39 | 22 | 61 |
| 2020 October | 38 | 14 | 52 |
| 2020 September | 46 | 17 | 63 |
| 2020 August | 22 | 19 | 41 |
| 2020 July | 27 | 15 | 42 |
| 2020 June | 40 | 38 | 78 |
| 2020 May | 42 | 21 | 63 |
| 2020 April | 35 | 14 | 49 |
| 2020 March | 37 | 16 | 53 |
| 2020 February | 8 | 7 | 15 |
| 2020 January | 4 | 9 | 13 |
| 2019 December | 8 | 1 | 9 |
| 2019 November | 3 | 0 | 3 |
| 2019 September | 10 | 1 | 11 |
| 2019 August | 4 | 0 | 4 |
| 2019 July | 4 | 10 | 14 |
| 2019 June | 4 | 1 | 5 |
| 2019 May | 9 | 8 | 17 |
| 2019 April | 2 | 23 | 25 |
| 2019 March | 0 | 7 | 7 |
| 2019 February | 5 | 2 | 7 |
| 2019 January | 0 | 5 | 5 |
| 2018 December | 4 | 0 | 4 |
| 2018 November | 4 | 0 | 4 |
| 2018 October | 5 | 0 | 5 |
| 2018 September | 5 | 0 | 5 |
| 2018 August | 0 | 4 | 4 |
| 2018 July | 0 | 3 | 3 |
| 2018 June | 0 | 1 | 1 |
| 2018 May | 0 | 12 | 12 |
| 2018 April | 0 | 1 | 1 |
| 2018 March | 2 | 5 | 7 |
| 2018 February | 58 | 15 | 73 |
| 2018 January | 69 | 4 | 73 |
| 2017 December | 73 | 11 | 84 |
| 2017 November | 52 | 14 | 66 |
| 2017 October | 54 | 17 | 71 |
| 2017 September | 43 | 7 | 50 |
| 2017 August | 69 | 10 | 79 |
| 2017 July | 35 | 20 | 55 |
| 2017 June | 56 | 8 | 64 |
| 2017 May | 42 | 11 | 53 |
| 2017 April | 33 | 13 | 46 |
| 2017 March | 14 | 15 | 29 |
| 2017 February | 15 | 15 | 30 |
| 2017 January | 15 | 7 | 22 |
| 2016 December | 29 | 27 | 56 |
| 2016 November | 41 | 19 | 60 |
| 2016 October | 29 | 16 | 45 |
| 2016 September | 0 | 6 | 6 |
| 2016 August | 0 | 9 | 9 |
| 2016 July | 0 | 1 | 1 |
| 2016 June | 4 | 4 | 8 |
| 2016 May | 0 | 2 | 2 |
| 2016 April | 1 | 1 | 2 |
| 2016 March | 0 | 9 | 9 |
| 2016 February | 0 | 10 | 10 |
| 2016 January | 0 | 9 | 9 |
| 2015 December | 0 | 1 | 1 |
| 2015 November | 0 | 4 | 4 |
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