Case and Research Letters
Punch Grafting for the Treatment of Martorell Hypertensive Ischemic Leg Ulcer
Tratamiento de la úlcera isquémica hipertensiva de Martorell con microinjertos autólogos en sello
Read
5847
Timeswas read the article
1955
Total PDF
3892
Total HTML
Share statistics
array:24 [ "pii" => "S1578219019302458" "issn" => "15782190" "doi" => "10.1016/j.adengl.2019.07.015" "estado" => "S300" "fechaPublicacion" => "2019-10-01" "aid" => "2095" "copyright" => "Elsevier España, S.L.U. and AEDV" "copyrightAnyo" => "2018" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2019;110:689-90" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2 "HTML" => 2 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0001731018304927" "issn" => "00017310" "doi" => "10.1016/j.ad.2018.06.016" "estado" => "S300" "fechaPublicacion" => "2019-10-01" "aid" => "2095" "copyright" => "AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2019;110:689-90" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 213 "formatos" => array:2 [ "HTML" => 146 "PDF" => 67 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta científico-clínica</span>" "titulo" => "Tratamiento de la úlcera isquémica hipertensiva de Martorell con microinjertos autólogos en sello" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "689" "paginaFinal" => "690" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Punch Grafting for the Treatment of Martorell Hypertensive Ischemic Leg Ulcer" ] ] "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" => 716 "Ancho" => 1255 "Tamanyo" => 129358 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A) Úlcera de 3<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>cm en cara lateral del tercio distal de la pierna derecha, de 2 meses de evolución. B) Cobertura con injertos en sello 2 semanas después. C) Epitelización completa a las 3 semanas de la intervención.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "S. Guisado Muñoz, E. Conde Montero, P. de la Cueva Dobao" "autores" => array:3 [ 0 => array:2 [ "nombre" => "S." "apellidos" => "Guisado Muñoz" ] 1 => array:2 [ "nombre" => "E." "apellidos" => "Conde Montero" ] 2 => array:2 [ "nombre" => "P." "apellidos" => "de la Cueva Dobao" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219019302458" "doi" => "10.1016/j.adengl.2019.07.015" "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/S1578219019302458?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731018304927?idApp=UINPBA000044" "url" => "/00017310/0000011000000008/v1_201910020711/S0001731018304927/v1_201910020711/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1578219019302501" "issn" => "15782190" "doi" => "10.1016/j.adengl.2018.03.022" "estado" => "S300" "fechaPublicacion" => "2019-10-01" "aid" => "2145" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2019;110:691-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Herpes Zoster Duplex and Multiplex: The Exception That Confirms the Rule" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "691" "paginaFinal" => "693" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La excepción que confirma la regla: herpes zoster duplex y multiplex" ] ] "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" => 1411 "Ancho" => 1500 "Tamanyo" => 258414 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Case 3. Herpes zoster multiplex presenting with clusters of vesicles in a zosteriform distribution affecting the L5 dermatome on the left leg (A and B, tibial crest and plantar arch) as well as D6 (C) on the left side and S2 (D) on the right side.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "E. Rodríguez-Lomba, A. Sánchez-Herrero, R. Suárez-Fernández, A. Pulido-Pérez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "E." "apellidos" => "Rodríguez-Lomba" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Sánchez-Herrero" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Suárez-Fernández" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Pulido-Pérez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S000173101930016X" "doi" => "10.1016/j.ad.2018.03.030" "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/S000173101930016X?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219019302501?idApp=UINPBA000044" "url" => "/15782190/0000011000000008/v1_201910050935/S1578219019302501/v1_201910050935/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1578219019302446" "issn" => "15782190" "doi" => "10.1016/j.adengl.2018.07.027" "estado" => "S300" "fechaPublicacion" => "2019-10-01" "aid" => "2043" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2019;110:687-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Videos of Surgical Procedures in Dermatology</span>" "titulo" => "Electrochemotherapy With Intravenous Bleomycin in the Treatment of Unresectable Merkel Cell Carcinoma" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "687" "paginaFinal" => "688" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Electroquimioterapia con bleomicina intravenosa en el tratamiento del carcinoma de células de Merkel irresecable" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L. Padilla-España, T. Toledo-Pastrana, A. Fernández-Orland, L. Ferrándiz-Pulido" "autores" => array:4 [ 0 => array:2 [ "nombre" => "L." "apellidos" => "Padilla-España" ] 1 => array:2 [ "nombre" => "T." "apellidos" => "Toledo-Pastrana" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Fernández-Orland" ] 3 => array:2 [ "nombre" => "L." "apellidos" => "Ferrándiz-Pulido" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731018303648" "doi" => "10.1016/j.ad.2018.07.007" "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/S0001731018303648?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219019302446?idApp=UINPBA000044" "url" => "/15782190/0000011000000008/v1_201910050935/S1578219019302446/v1_201910050935/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Punch Grafting for the Treatment of Martorell Hypertensive Ischemic Leg Ulcer" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the Editor:</span>" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "689" "paginaFinal" => "690" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "S. Guisado Muñoz, E. Conde Montero, P. de la Cueva Dobao" "autores" => array:3 [ 0 => array:4 [ "nombre" => "S." "apellidos" => "Guisado Muñoz" "email" => array:1 [ 0 => "sole_dad72@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "E." "apellidos" => "Conde Montero" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "P." "apellidos" => "de la Cueva Dobao" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Centro de especialidades Vicente Soldevilla, Madrid, España" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Infanta Leonor, Madrid, España" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tratamiento de la úlcera isquémica hipertensiva de Martorell con microinjertos autólogos en sello" ] ] "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" => 716 "Ancho" => 1255 "Tamanyo" => 129778 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Ulcer measuring 3<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>cm on the lateral surface of the distal third of the right leg, which had appeared 3 months earlier. B, Coverage with punch grafts 2 weeks later. C, Complete epithelization 3 weeks after the intervention.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Martorell hypertensive ischemic leg ulcer (HYTILU) is an ischemic lesion caused by the obstruction of small arterioles, in the absence of signs of vasculitis; it is frequently refractive and is extremely painful. Clinical presentation is characterized by rapid growth and difficult pain management.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1,2</span></a> While there is no benchmark treatment for this lesion, it is essential to manage the inflammation and pain. The most common form of management, with dressing in a moist environment, provides unsatisfactory results. Treatment with punch grafting,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> however, is associated with greater anti-inflammatory and analgesic capacity, and shorter healing time.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">2,4,5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We report 3 clinical cases of Martorell HYTILU treated with punch grafting, with effective pain management and complete healing in 3 to 8 weeks. The patients were aged between 72 and 83 years and all of them had a history of hypertension and dyslipidemia. One of the patients had diabetes mellitus. They presented ulcers with similar clinical characteristics, with an erythematous-violaceous lesion that was painful to the touch, with irregular hyperemic borders, slough in the wound bed with lacunar infarcts, no clinical data suggesting infection, and a context of phlebolymphedema (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). The lesions were located on the distal and medial third of the anterior, lateral, and posterior surface of the lower extremities, and had developed over periods ranging from 2 months to 3 years; all the lesions were associated with traumatic triggering events. In the initial clinical assessment, the mean pain score on a visual analog scale (VAS) was 10/10, with pain occurring predominantly at night, and with no improvement after analgesic treatment, even with opioids, or after elevating the affected extremity. The distal pulses were present and the ankle-brachial pressure index (ABPI) was approximately 1 (normal range) in all the patients. Blood and urine workup revealed no significant findings. Blood pressure and glucose were normal during the healing process in all patients.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Initial treatment was with betamethasone 0.5% cream on the borders every 72<span class="elsevierStyleHsp" style=""></span>hours for 15 days, autolytic debridement with twice-weekly dressing in a moist environment, and low-elasticity compression bandages (minimum estimated pressure, 20<span class="elsevierStyleHsp" style=""></span>mmHg). This management provided adequate preparation of the bed in a period of between 2 and 3 weeks, with reduction of pain on the VAS of between 2 and 3 points. After adequate granulation tissue was obtained in the wound bed, fine punch grafting was performed (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). The patient was instructed to rest the limb during the first 5 days after the grafting procedure and wound care involved changing the dressing once per week (bioactive protease-inhibiting dressing with a polyester mesh and alginate as a secondary dressing), combined with compression bandages; the graft take rate was between 90% and 100%. Full epithelization was achieved between 3 and 8 weeks after grafting (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C). No complications were recorded at the donor site (anterior lateral surface of the thigh) or at the recipient site.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Diagnosis of Martorell HYTILU is essentially clinical, although it has its own characteristic histology, which will reveal obstruction of the subcutaneous arterioles. The etiology and pathogenesis of the lesion are still not fully understood, although some studies associate the lesion with a history of long-term hypertension; however, hypertension, whether properly managed or not, is not considered sufficient and must therefore be associated with other abnormalities. The lesion is frequently associated with underlying diseases such as diabetes, obesity, chronic venous insufficiency, and peripheral artery disease. The most common local management option is dressing in a moist environment with bioactive bandages, despite the fact that this does not control the inflammatory process in Martorell HYTILU.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1,2</span></a> Different authors have reported the analgesic effect of fine punch grafting in Martorell HYTILU.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">2,4</span></a> These split-thickness “postage-stamp” grafts, obtained using a punch, curette, or scalpel, include the epidermis and dermis, down to the superficial papillary dermis.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> In wounds with a considerable amount of slough, although the graft does not take adequately, vasodilating cytokines, growth factors and angiogenic factors are still released, which allows for modulation in arteriolar vasospasm.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> The analgesic effect of punch grafting, without prior administration of analgesics, has been reported 5<span class="elsevierStyleHsp" style=""></span>hours after the grafting procedure, with regression of the erythematous-violaceous halo between 3 and 17 days after the graft.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Adjuvant negative-pressure therapy is an interesting therapeutic option for promoting punch graft take, mainly in suboptimal beds and beds in complicated anatomical locations, such as the Achilles tendon.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In our 3 cases of Martorell HYTILU, punch grafting allowed for healing periods of less than 2 months, with control of the associated pain. It is a safe and efficient therapeutic option that is easy to apply in the outpatient setting, with low additional morbidity for the patient.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of Interest" ] 1 => 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: Guisado Muñoz S. Tratamiento de la úlcera isquémica hipertensiva de Martorell con microinjertos autólogos en sello. Actas Dermosifiliogr. 2019;110:689–690.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 716 "Ancho" => 1255 "Tamanyo" => 129778 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Ulcer measuring 3<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>cm on the lateral surface of the distal third of the right leg, which had appeared 3 months earlier. B, Coverage with punch grafts 2 weeks later. C, Complete epithelization 3 weeks after the intervention.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Arteriolosclerotic ulcer of Martorell" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.D. Vuerstaek" 1 => "S.W. Reeder" 2 => "C.J. Henquet" 3 => "H.A. Neumann" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1468-3083.2009.03553.x" "Revista" => array:6 [ "tituloSerie" => "J Eur Acad Dermatol Venereol" "fecha" => "2010" "volumen" => "24" "paginaInicial" => "867" "paginaFinal" => "874" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20113382" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0045" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Martorell hypertensive ischemic leg ulcer: A model of ischemic subcutaneous arteriolosclerosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Hafner" 1 => "S. Nobbe" 2 => "H. Partsch" 3 => "S. Läuchli" 4 => "D. Mayer" 5 => "B. Amann-Vesti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archdermatol.2010.224" "Revista" => array:7 [ "tituloSerie" => "Arch Dermatol" "fecha" => "2010" "volumen" => "146" "paginaInicial" => "961" "paginaFinal" => "968" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20855694" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673610620569" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0050" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Greffes cutanées. En: Encycl Med Chir (EMC). Techniques chirurgicales. Chirurgie plastique reconstructive et esthétique" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Revol" 1 => "J.M. Servant" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:5 [ "fecha" => "2010" "paginaInicial" => "45" "paginaFinal" => "70" "editorial" => "Elsevier-Masson" "editorialLocalizacion" => "Issy-les-Moulineaux" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0055" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Interest of punch skin grafting for the treatment of painful ulcers" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Fourgeaud" 1 => "G. Mouloise" 2 => "U. Michon-Pasturel" 3 => "S. Bonhomme" 4 => "I. Lazareth" 5 => "S. Meaume" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jmv.2016.08.001" "Revista" => array:6 [ "tituloSerie" => "J Mal Vasc" "fecha" => "2016" "volumen" => "41" "paginaInicial" => "323" "paginaFinal" => "328" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27596566" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0060" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Punch-grafting to enhance healing and to reduce pain in complicated leg and foot ulcers" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Nordström" 1 => "C. Hansson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2340/00015555-0443" "Revista" => array:7 [ "tituloSerie" => "Acta Derm Venereol" "fecha" => "2008" "volumen" => "88" "paginaInicial" => "389" "paginaFinal" => "391" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18709311" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673611603589" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0065" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "L’ulcère de jambe chez la personne âgée" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Meaume" 1 => "C. Debure" 2 => "I. Lazareth" 3 => "L. Teot" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:4 [ "fecha" => "2002" "paginaInicial" => "110p" "editorial" => "Edition John Libbey Eurotext" "editorialLocalizacion" => "Paris" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0070" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "State-of-the-art treatment of chronic leg ulcers: A randomized controlled trial comparing vacuum-assisted closure (VAC) with modern wound dressings" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.D. Vuerstaek" 1 => "T. Vainas" 2 => "J. Wuite" 3 => "P. Nelemans" 4 => "M.H. Neumann" 5 => "J.C. Veraart" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jvs.2006.07.030" "Revista" => array:6 [ "tituloSerie" => "J Vasc Surg" "fecha" => "2006" "volumen" => "44" "paginaInicial" => "1029" "paginaFinal" => "1037" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17000077" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000011000000008/v1_201910050935/S1578219019302458/v1_201910050935/en/main.assets" "Apartado" => array:4 [ "identificador" => "6157" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000011000000008/v1_201910050935/S1578219019302458/v1_201910050935/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219019302458?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 15 | 12 | 27 |
| 2024 October | 93 | 74 | 167 |
| 2024 September | 84 | 45 | 129 |
| 2024 August | 118 | 68 | 186 |
| 2024 July | 80 | 37 | 117 |
| 2024 June | 118 | 47 | 165 |
| 2024 May | 108 | 39 | 147 |
| 2024 April | 89 | 38 | 127 |
| 2024 March | 99 | 35 | 134 |
| 2024 February | 79 | 43 | 122 |
| 2024 January | 72 | 45 | 117 |
| 2023 December | 66 | 33 | 99 |
| 2023 November | 89 | 47 | 136 |
| 2023 October | 100 | 56 | 156 |
| 2023 September | 64 | 35 | 99 |
| 2023 August | 67 | 18 | 85 |
| 2023 July | 87 | 41 | 128 |
| 2023 June | 76 | 27 | 103 |
| 2023 May | 97 | 34 | 131 |
| 2023 April | 77 | 23 | 100 |
| 2023 March | 66 | 29 | 95 |
| 2023 February | 55 | 23 | 78 |
| 2023 January | 50 | 25 | 75 |
| 2022 December | 88 | 34 | 122 |
| 2022 November | 70 | 32 | 102 |
| 2022 October | 51 | 33 | 84 |
| 2022 September | 71 | 45 | 116 |
| 2022 August | 44 | 28 | 72 |
| 2022 July | 46 | 51 | 97 |
| 2022 June | 31 | 33 | 64 |
| 2022 May | 65 | 42 | 107 |
| 2022 April | 81 | 38 | 119 |
| 2022 March | 74 | 69 | 143 |
| 2022 February | 90 | 36 | 126 |
| 2022 January | 96 | 32 | 128 |
| 2021 December | 75 | 44 | 119 |
| 2021 November | 79 | 48 | 127 |
| 2021 October | 94 | 59 | 153 |
| 2021 September | 71 | 43 | 114 |
| 2021 August | 71 | 32 | 103 |
| 2021 July | 43 | 20 | 63 |
| 2021 June | 45 | 26 | 71 |
| 2021 May | 68 | 41 | 109 |
| 2021 April | 189 | 74 | 263 |
| 2021 March | 95 | 36 | 131 |
| 2021 February | 72 | 21 | 93 |
| 2021 January | 70 | 21 | 91 |
| 2020 December | 59 | 21 | 80 |
| 2020 November | 25 | 14 | 39 |
| 2020 October | 35 | 10 | 45 |
| 2020 September | 23 | 15 | 38 |
| 2020 August | 27 | 20 | 47 |
| 2020 July | 17 | 12 | 29 |
| 2020 June | 21 | 21 | 42 |
| 2020 May | 19 | 10 | 29 |
| 2020 April | 13 | 8 | 21 |
| 2020 March | 22 | 10 | 32 |
| 2020 February | 1 | 2 | 3 |
| 2019 November | 1 | 0 | 1 |
| 2019 August | 1 | 0 | 1 |
Show all
