array:25 [
  "pii" => "S1578219020300251"
  "issn" => "15782190"
  "doi" => "10.1016/j.adengl.2020.03.003"
  "estado" => "S300"
  "fechaPublicacion" => "2020-04-01"
  "aid" => "2286"
  "copyright" => "AEDV"
  "copyrightAnyo" => "2019"
  "documento" => "article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "fla"
  "cita" => "Actas Dermosifiliogr. 2020;111:229-35"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:1 [
    "total" => 0
  ]
  "Traduccion" => array:1 [
    "es" => array:20 [
      "pii" => "S0001731019303886"
      "issn" => "00017310"
      "doi" => "10.1016/j.ad.2019.06.004"
      "estado" => "S300"
      "fechaPublicacion" => "2020-04-01"
      "aid" => "2286"
      "copyright" => "AEDV"
      "documento" => "article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "fla"
      "cita" => "Actas Dermosifiliogr. 2020;111:229-35"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:1 [
        "total" => 0
      ]
      "es" => array:14 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">DERMATOLOG&#205;A PR&#193;CTICA</span>"
        "titulo" => "Ectropi&#243;n en cirug&#237;a dermatol&#243;gica&#58; exploraci&#243;n y t&#233;cnicas reconstructivas"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:3 [
          0 => "es"
          1 => "es"
          2 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "229"
            "paginaFinal" => "235"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Ectropion in Dermatologic Surgery&#58; Exploration and Reconstruction Techniques"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 1
          "multimedia" => array:5 [
            "identificador" => "fig0050"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => false
            "mostrarDisplay" => true
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "fx1.jpeg"
                "Alto" => 895
                "Ancho" => 1333
                "Tamanyo" => 69100
              ]
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "P&#46; Fern&#225;ndez Canga, E&#46; Varas Meis, J&#46; Casti&#241;eiras Gonz&#225;lez, C&#46; Prada Garc&#237;a, M&#46;&#193;&#46; Rodr&#237;guez Prieto"
            "autores" => array:5 [
              0 => array:2 [
                "nombre" => "P&#46;"
                "apellidos" => "Fern&#225;ndez Canga"
              ]
              1 => array:2 [
                "nombre" => "E&#46;"
                "apellidos" => "Varas Meis"
              ]
              2 => array:2 [
                "nombre" => "J&#46;"
                "apellidos" => "Casti&#241;eiras Gonz&#225;lez"
              ]
              3 => array:2 [
                "nombre" => "C&#46;"
                "apellidos" => "Prada Garc&#237;a"
              ]
              4 => array:2 [
                "nombre" => "M&#46;&#193;&#46;"
                "apellidos" => "Rodr&#237;guez Prieto"
              ]
            ]
          ]
        ]
        "resumen" => array:1 [
          0 => array:3 [
            "titulo" => "Graphical abstract"
            "clase" => "graphical"
            "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><elsevierMultimedia ident="fig0050"></elsevierMultimedia></p></span>"
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S1578219020300251"
          "doi" => "10.1016/j.adengl.2020.03.003"
          "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/S1578219020300251?idApp=UINPBA000044"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731019303886?idApp=UINPBA000044"
      "url" => "/00017310/0000011100000003/v3_202009190646/S0001731019303886/v3_202009190646/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:20 [
    "pii" => "S1578219020300378"
    "issn" => "15782190"
    "doi" => "10.1016/j.adengl.2020.03.010"
    "estado" => "S300"
    "fechaPublicacion" => "2020-04-01"
    "aid" => "2285"
    "copyright" => "AEDV"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "ssu"
    "cita" => "Actas Dermosifiliogr. 2020;111:236-42"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Novelties in Dermatology</span>"
      "titulo" => "Ex Vivo Confocal Microscopy Using Fusion Mode and Digital Staining&#58; Changing Paradigms in Histological Diagnosis"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "236"
          "paginaFinal" => "242"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Microscopia confocal <span class="elsevierStyleItalic">ex vivo</span> con m&#233;todo de fusi&#243;n y tinci&#243;n digital&#58; cambiando paradigmas en el diagn&#243;stico histol&#243;gico"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig0010"
          "etiqueta" => "Figure 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 1236
              "Ancho" => 2500
              "Tamanyo" => 584995
            ]
          ]
          "detalles" => array:1 [
            0 => array:3 [
              "identificador" => "at0010"
              "detalle" => "Figure "
              "rol" => "short"
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Image of normal skin in different modes&#58; A&#44; fluorescence&#59; B&#44; reflectance&#59; C&#44; fusion&#59; D&#44; digital hematoxylin&#8211;eosin&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "J P&#233;rez-Anker, J Malvehy, D Moreno-Ram&#237;rez"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "J"
              "apellidos" => "P&#233;rez-Anker"
            ]
            1 => array:2 [
              "nombre" => "J"
              "apellidos" => "Malvehy"
            ]
            2 => array:2 [
              "nombre" => "D"
              "apellidos" => "Moreno-Ram&#237;rez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0001731019303874"
        "doi" => "10.1016/j.ad.2019.05.005"
        "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/S0001731019303874?idApp=UINPBA000044"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219020300378?idApp=UINPBA000044"
    "url" => "/15782190/0000011100000003/v1_202005050702/S1578219020300378/v1_202005050702/en/main.assets"
  ]
  "itemAnterior" => array:20 [
    "pii" => "S1578219020300329"
    "issn" => "15782190"
    "doi" => "10.1016/j.adengl.2020.03.008"
    "estado" => "S300"
    "fechaPublicacion" => "2020-04-01"
    "aid" => "2289"
    "copyright" => "AEDV"
    "documento" => "simple-article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "pgl"
    "cita" => "Actas Dermosifiliogr. 2020;111:222-8"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Consensus Document</span>"
      "titulo" => "A Review of the Latest Recommendations on the Management of Chronic Urticaria&#58; A Multidisciplinary Consensus Statement From Andalusia&#44; Spain"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "222"
          "paginaFinal" => "228"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Revisi&#243;n de las &#250;ltimas novedades en el manejo del paciente con urticaria cr&#243;nica&#58; Consenso multidisciplinar de la comunidad aut&#243;noma de Andaluc&#237;a"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 522
              "Ancho" => 1508
              "Tamanyo" => 37170
            ]
          ]
          "detalles" => array:1 [
            0 => array:3 [
              "identificador" => "at0005"
              "detalle" => "Figure "
              "rol" => "short"
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Association between Urticaria Activity Score 7 &#40;UAS7&#41;&#44; disease control&#44; and changes to treatment&#46; The experts agreed that a UAS7 score of over 7 indicates poor disease control and that the patient should be switched to another treatment&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "M&#46; Alc&#225;ntara Villar, J&#46;C&#46; Armario Hita, S&#46; Cimbollek, M&#46;D&#46; Fern&#225;ndez Ballesteros, M&#46; Gal&#225;n Guti&#233;rrez, C&#46; Hern&#225;ndez Montoya, M&#46;&#193;&#46; Lara-Jim&#233;nez, J&#46;J&#46; Pereyra Rodr&#237;guez, J&#46;M&#46; Vega Chicote, R&#46; Ruiz-Villaverde"
          "autores" => array:10 [
            0 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Alc&#225;ntara Villar"
            ]
            1 => array:2 [
              "nombre" => "J&#46;C&#46;"
              "apellidos" => "Armario Hita"
            ]
            2 => array:2 [
              "nombre" => "S&#46;"
              "apellidos" => "Cimbollek"
            ]
            3 => array:2 [
              "nombre" => "M&#46;D&#46;"
              "apellidos" => "Fern&#225;ndez Ballesteros"
            ]
            4 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Gal&#225;n Guti&#233;rrez"
            ]
            5 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Hern&#225;ndez Montoya"
            ]
            6 => array:2 [
              "nombre" => "M&#46;&#193;&#46;"
              "apellidos" => "Lara-Jim&#233;nez"
            ]
            7 => array:2 [
              "nombre" => "J&#46;J&#46;"
              "apellidos" => "Pereyra Rodr&#237;guez"
            ]
            8 => array:2 [
              "nombre" => "J&#46;M&#46;"
              "apellidos" => "Vega Chicote"
            ]
            9 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "Ruiz-Villaverde"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0001731019303916"
        "doi" => "10.1016/j.ad.2019.04.009"
        "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/S0001731019303916?idApp=UINPBA000044"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219020300329?idApp=UINPBA000044"
    "url" => "/15782190/0000011100000003/v1_202005050702/S1578219020300329/v1_202005050702/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Practical Dermatology</span>"
    "titulo" => "Ectropion in Dermatologic Surgery&#58; Exploration and Reconstruction Techniques"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "229"
        "paginaFinal" => "235"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "P&#46; Fern&#225;ndez Canga, E&#46; Varas Meis, J&#46; Casti&#241;eiras Gonz&#225;lez, C&#46; Prada Garc&#237;a, M&#46;&#193;&#46; Rodr&#237;guez Prieto"
        "autores" => array:5 [
          0 => array:4 [
            "nombre" => "P&#46;"
            "apellidos" => "Fern&#225;ndez Canga"
            "email" => array:1 [
              0 => "paulafcanga@gmail.com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "&#42;"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:2 [
            "nombre" => "E&#46;"
            "apellidos" => "Varas Meis"
          ]
          2 => array:2 [
            "nombre" => "J&#46;"
            "apellidos" => "Casti&#241;eiras Gonz&#225;lez"
          ]
          3 => array:2 [
            "nombre" => "C&#46;"
            "apellidos" => "Prada Garc&#237;a"
          ]
          4 => array:2 [
            "nombre" => "M&#46;&#193;&#46;"
            "apellidos" => "Rodr&#237;guez Prieto"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Servicio de Dermatolog&#237;a&#44; Complejo Asistencial Universitario de Le&#243;n&#44; Le&#243;n&#44; Spain"
            "identificador" => "aff0005"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Ectropi&#243;n en cirug&#237;a dermatol&#243;gica&#58; exploraci&#243;n y t&#233;cnicas reconstructivas"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:8 [
        "identificador" => "fig0040"
        "etiqueta" => "Figure 8"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr8.jpeg"
            "Alto" => 1575
            "Ancho" => 2500
            "Tamanyo" => 615108
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0040"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Canthoplasty&#46; A&#44; Postsurgical eversion of the lower eyelid in a 65-year-old woman with moderate-severe horizontal laxity&#46; B&#44; Lateral canthoplasty for eyelid repositioning&#58; horizontal incision of 1&#8239;cm in the anterior lamella through the external canthus&#44; leaving the canthal ligament exposed&#46; Location of the anchoring point that corrects the defect and attachment of the ligament to the periosteum of the internal face of the orbital rim with an absorbable 5&#47;0 suture&#44; at 2&#8239;mm above the internal canthus&#46; C&#44; Skin suture by direct closure with 5&#47;0 silk &#40;<a class="elsevierStyleCrossRef" href="#fig0035">Fig&#46; 7</a>B and C&#41;&#46; D and E&#44; Good functional and esthetic outcome at 8 weeks&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The lower eyelid is subdivided into the anterior lamella &#40;skin and orbicularis oculi muscle&#41;&#44; medial lamella &#40;orbital septum&#44; orbital fat&#41;&#44; and the posterior lamella &#40;capsulopalpebral fascia&#44; tarsus&#44; and conjunctiva&#41;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; In its physiological position&#44; it has a protective function and participates in tear film homeostasis&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a> The free border of the lower eyelid should be level with the corneal limbus&#46; The eyelid is kept in this position by the following supporting structures&#58; medial and lateral canthal tendons&#44; the elements comprising the medial lamella&#44; and the posterior lamellar retractors &#40;capsulopalpebral fascia&#44; Lockwood ligament&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Ectropion occurs on eversion of the eyelid&#44; such that the internal surface is exposed&#44; potentially giving rise to epiphora&#44; lagophthalmos&#44; chronic irritation&#44; keratitis&#44; pain&#44; and ulceration&#46; Ectropion is the most frequent eyelid malposition&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">There are 5 types of ectropion&#58; congenital&#44; paralytic&#44; involutional&#44; cicatricial&#44; and mechanical&#46; Congenital ectropion is extremely rare and usually occurs due to vertical skin foreshortening in blepharophimosis syndrome&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2&#44;6</span></a> Paralytic ectropion is caused by paresis of the orbicularis oculi muscle&#44; generally as a result of facial nerve paralysis&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> Involutional or senile ectropion is the most frequent type&#44;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a> and is caused by laxity&#44; atrophy&#44; or disinsertion of the supporting structures &#40;tarsus&#44; orbital septum&#44; ligaments&#44; canthal tendons&#44; and retractors&#41;&#44; and loss of elasticity and decreased orbital and malar fat&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> Cicatricial and mechanical ectropion are due to a vertical vector that exerts a tractional force on the eyelid&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In cicatricial ectropion&#44; the most frequent cause is foreshortening of the anterior lamella due to mechanical&#44; chemical&#44; or thermal damage or postoperative cicatricial retractions&#46; The most common causes of mechanical ectropion include periorbital edema and tumors&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Periorbital tumors&#44; in addition to causing mechanical ectropion&#44; may indirectly give rise to cicatricial ectropion through reconstruction with excessive vertical tightening after excision&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Examination Techniques</span><p id="par0025" class="elsevierStylePara elsevierViewall">Appropriate eyelid examination should be conducted prior to all types of periocular surgery&#46; This will determine the risk of postoperative ectropion and enable compensatory elements to be included when planning the operation&#46; When ectropion is already present&#44; examination will serve to determine the predominant pathogenic component and enable the most appropriate repair technique to be chosen&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">There are 4 simple tests to determine eyelid laxity&#44; the snap back test and the vertical&#44; lateral&#44; and medial distraction tests &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Pulling the lower eyelid can evidence excessive laxity if there is a delay in the eyelid returning to its original position &#40;snap back test&#41; or if the eyelid separates more than 8&#8239;mm from the eyeball &#40;vertical distraction test&#41;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>a&#41;&#46; Medial distraction would reveal lateral canthal hyperlaxity in the event that the outer corner of the eye extends more than 2&#8239;mm &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>b&#41; and&#44; finally&#44; lateral distraction would show hyperlaxity of the medial canthus if the lacrimal punctum is pulled than 2&#8239;mm<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>c&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The predominant elements in the above tests would allow the most appropriate preventive or corrective surgical technique to be chosen&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Surgical Techniques to Prevent Ectropion</span><p id="par0040" class="elsevierStylePara elsevierViewall">Excessive eyelid laxity is common in elderly individuals&#44; with tumors being the most common underlying cause&#46; Thus&#44; when planning surgery for a tumor in the lower eyelid in patients with excessive eyelid laxity&#44; reduction of the horizontal component or inclusion of corrective techniques should be contemplated&#44; ideally at the same time as surgery&#44; in order to prevent the onset of postoperative ectropion&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The Frost suspension suture&#44; described in 1934&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> aims to bring the lower eyelid to its anatomical position in the immediate postoperative period&#46; The technique consists of anchoring the inferior tarsus temporarily with a nonabsorbable suture that is fixed to the supraciliary space by simply stitches or with adhesive strips &#40;enabling retightening during the healing process&#41;&#46; This technique can prevent the formation of postoperative ectropion due to edema formation or hemorrhage in the immediate postoperative period&#46; If the suture is centrally positioned&#44; the eye should be kept occluded due to the risk of corneal abrasion and there is a risk of skin erosion with excessive tightening&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">A tumor excision pattern in wedge or pentagonal form<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> can shorten the lower eyelid at the same time as the tumor is removed&#44; thereby achieving both the oncological and reconstructive goal&#44; and avoiding ectropion &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Repositioning of the central canthus is a key compensatory element that should be associated with any reconstructive procedure in the lower eyelid to help prevent ectropion formation&#46; Two surgical techniques that can prevent or correct eyelid eversion by canthal repositioning are canthopexy and canthoplasty&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a> shows the techniques that aim to prevent the formation of ectropion by cause&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Surgical Techniques for Ectropion Correction</span><p id="par0065" class="elsevierStylePara elsevierViewall">The aim of repair of cicatricial or mechanical ectropion is to eliminate cause of the tractional element&#46; This is achieved using a Z-plasty or excising the lesion that is responsible for the vertical tensile force on the lower eyelid &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Ectropion resulting from loss of volume can be corrected by providing tissue in the form of a flap or graft&#44; or with synthetic materials&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;9&#44;14</span></a> One of the most widely used flaps is the Tripier flap&#44; in which skin and muscle are taken from the upper eyelid &#40;<a class="elsevierStyleCrossRef" href="#fig0030">Fig&#46; 6</a>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;16</span></a> In the case of grafting&#44; the most appropriate areas for donor skin are the upper eyelid and the preauricular and retroauricular region&#44; as the skin in those regions has a similar thickness and texture&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;6&#44;17&#44;18</span></a> Finally&#44; synthetic materials are a valid alternative to autologous grafts&#44; although they are less widely used given their high cost and greater risk of contraction&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><elsevierMultimedia ident="fig0030"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Treatment of postoperative ectropion in patients with eyelid laxity &#40;involutional component&#41; aims to achieve horizontal tightening&#46; This is achieved by repositioning of the lateral canthus by canthopexy or cantoplasty&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Canthopexy aims to tighten the lateral canthal tendon by attaching it to the lateral orbital rim without the need for canthotomy &#40;incision and extension of the medial canthus&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0035">Fig&#46; 7</a>&#41;&#46; This is used in cases of mild hyperlaxity&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> In contrast&#44; canthoplasty is used to correct more severe hyperlaxities and requires canthotomy before anchoring the outer canthus &#40;<a class="elsevierStyleCrossRef" href="#fig0040">Fig&#46; 8</a>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;4&#44;6&#44;12</span></a> One of the most widely used canthoplasty procedures is the tarsal strip in which the free border of the inferior tarsus is released and deepithelialized to form a strip that is subsequently anchored to the orbital rim to form a neocanthus&#46; The anchor point for the canthal repositioning is level with the periosteum&#44; in the internal face of the lateral orbital rim&#44; 2&#8239;mm above the medial canthus&#44; so that the tears follow a superolateral or inferomedial pathway and can provide appropriate lubrication&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><elsevierMultimedia ident="fig0035"></elsevierMultimedia><elsevierMultimedia ident="fig0040"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Correction of severe ectropion&#44; in which postoperative retraction is combined with excessive eyelid laxity&#44; may require a combination of the 2 techniques&#44; that is&#44; elimination of the cicatricial component and canthal repositioning&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0045">Fig&#46; 9</a> shows the surgical techniques for repairing ectropion by cause&#46;</p><elsevierMultimedia ident="fig0045"></elsevierMultimedia></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conclusion</span><p id="par0090" class="elsevierStylePara elsevierViewall">Knowledge of basic eyelid anatomy and adequate preoperative examination will enable the dermatologic surgeon to design the most effective surgical procedures to avoid ectropion&#44; or&#44; if applicable&#44; choose the best type of repair surgery according to the predominant causal component&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conflicts of interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:9 [
        0 => array:3 [
          "identificador" => "xres1332891"
          "titulo" => "Abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0005"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1227998"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres1332892"
          "titulo" => "Resumen"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0010"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1227997"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Examination Techniques"
          "secciones" => array:2 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Surgical Techniques to Prevent Ectropion"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Surgical Techniques for Ectropion Correction"
            ]
          ]
        ]
        6 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Conclusion"
        ]
        7 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Conflicts of interest"
        ]
        8 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2019-01-09"
    "fechaAceptado" => "2019-06-11"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1227998"
          "palabras" => array:5 [
            0 => "Ectropion"
            1 => "Surgical reconstruction procedures"
            2 => "Dermatologic surgical procedures"
            3 => "Skin surgery"
            4 => "Cosmetic techniques"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1227997"
          "palabras" => array:5 [
            0 => "Ectropion"
            1 => "Procedimientos quir&#250;rgicos reconstructivos"
            2 => "Procedimientos dermatol&#243;gicos quir&#250;rgicos"
            3 => "Cirug&#237;a cut&#225;nea"
            4 => "T&#233;cnicas cosm&#233;ticas"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Ectropion&#44; or eyelid eversion&#44; is the most common form of eyelid malposition&#46; By impairing the eyelid&#8217;s protective function&#44; ectropion can cause epiphora&#44; lagophthalmos&#44; keratinization&#44; chronic irritation&#44; pain&#44; and ulceration&#46; There are 5 types of ectropion&#44; each with a different cause&#58; congenital&#44; paralytic&#44; involutional&#44; cicatricial&#44; and mechanical&#46; The most common presentation in dermatology is involutional eversion with a mechanical or tractional element&#46; Several options exist for the surgical repair of ectropion and choice of technique will depend on the main pathogenic component&#46; We review the basic anatomy of the eyelid and describe examination techniques for assessing risk and preventing ectropion and for identifying the main pathogenic component in order to select the most suitable repair technique&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">El ectropion o eversi&#243;n del p&#225;rpado&#44; es la malposici&#243;n palpebral m&#225;s frecuente&#46; Al alterar la funci&#243;n protectora palpebral puede causar ep&#237;fora&#44; lagoftalmos&#44; queratinizaci&#243;n&#44; irritaci&#243;n cr&#243;nica&#44; dolor o ulceraci&#243;n&#46; Se distinguen 5 tipos de ectropion en funci&#243;n de su mecanismo causal&#58; cong&#233;nito&#44; paral&#237;tico&#44; involutivo&#44; cicatricial y mec&#225;nico&#46; Lo m&#225;s habitual en dermatolog&#237;a&#44; es la presencia de ectropi&#243;n de tipo mixto&#44; con elementos involutivos y mec&#225;nico-traccionales&#46; Existen varias t&#233;cnicas reparadoras de ectropion cuya indicaci&#243;n depender&#225; del componente patog&#233;nico principal&#46; Revisamos la anatom&#237;a b&#225;sica palpebral y exponemos la t&#233;cnica exploratoria que nos permitir&#225; analizar el riesgo de ectropion para prevenir su aparici&#243;n o determinar la patogenia del ectropi&#243;n ya establecido para definir la t&#233;cnica reparadora m&#225;s apropiada&#46;</p></span>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Fern&#225;ndez Canga P&#44; Varas Meis E&#44; Casti&#241;eiras Gonz&#225;lez J&#44; Prada Garc&#237;a C&#44; Rodr&#237;guez Prieto M&#193;&#46; Ectropi&#243;n en cirug&#237;a dermatol&#243;gica&#58; exploraci&#243;n y t&#233;cnicas reconstructivas&#46; Actas Dermosifiliogr&#46; 2020&#59;111&#58;229&#8211;235&#46;</p>"
      ]
    ]
    "multimedia" => array:9 [
      0 => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1006
            "Ancho" => 1500
            "Tamanyo" => 89623
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Basic eyelid anatomy&#46; Anterior lamella &#40;skin and orbicularis oculi muscle&#41;&#44; medial lamella &#40;orbital septum and orbital fat&#41;&#44; and posterior lamella &#40;capsulopalpebral fascia&#44; tarsus&#44; and conjunctiva&#41;&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 623
            "Ancho" => 2500
            "Tamanyo" => 155425
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0010"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Examination techniques&#46; A&#44; Snap back test and vertical distraction test&#58; excessive laxity is observed if there is a delay in the eyelid returning to its original position or if the eyelid separates more than 8&#8239;mm from the eyeball with vertical pulling&#44; respectively&#46; B&#44; Medial distraction test&#58; lateral canthal hyperlaxity if the outer corner of the eye can be pulled more than 2&#8239;mm&#46; C&#44; Lateral distraction test&#58; hyperlaxity of the medial canthus if the lacrimal punctum moves more than 2&#8239;mm&#46; Source&#58; Fern&#225;ndez-Canga et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1607
            "Ancho" => 2500
            "Tamanyo" => 598768
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0015"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Pentagonal excision&#46; A&#44; Basal cell carcinoma in the lower right eyelid in an 85-year-old male patient with mixed ectropion &#40;involutional and mechanical caused by the tumor&#41;&#46; B and C&#44; Pentagonal tumor resection was designed to achieve the oncological objective as well as the reconstructive one&#44; by avoiding ectropion with a reduction in the horizontal component of the eyelid&#46; Outcome of the technique immediately after the procedure &#40;D&#41; and at 8 weeks &#40;E&#41;&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "fig0020"
        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 1209
            "Ancho" => 2500
            "Tamanyo" => 180563
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0020"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Algorithm for preventive surgical techniques for ectropion&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "fig0025"
        "etiqueta" => "Figure 5"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr5.jpeg"
            "Alto" => 1474
            "Ancho" => 2500
            "Tamanyo" => 729576
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0025"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Z-plasty&#46; A&#44; 54-year-old patient with spindle-cell carcinoma in the infraorbital region&#46; B&#44; Surgical defect and reconstruction design with a glabellar and cheek combined flap&#46; C&#44; Multicomponent&#44; severe postoperative ectropion&#44; with cicatricial elements&#44; loss of volume and involution&#46; Symptoms of lagophthalmos and accompanying conjunctival hemorrhage&#46; D and E&#44; For correction&#44; the vertical cicatricial tensile force was released by Z-plasty&#46; F&#44; Late postoperative outcome &#40;at 8 weeks&#41;&#58; repositioning of the lower eyelid&#46;</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "fig0030"
        "etiqueta" => "Figure 6"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr6.jpeg"
            "Alto" => 1293
            "Ancho" => 2500
            "Tamanyo" => 562520
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0030"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Tripier flap&#46; A&#44; Tractional postoperative ectropion with lack of volume in the lower eyelid&#46; B&#44; Design of a transposition flap from the upper eyelid or Tripier flap&#46; C&#44; Final positioning of the flap after making an incision immediately below the eyelash line in the lower eyelid&#44; dissection and transposition of the flap&#46; D&#44; Immediate postoperative outcome&#46; E and F&#44; Late postoperative outcome at 8 weeks&#46;</p>"
        ]
      ]
      6 => array:8 [
        "identificador" => "fig0035"
        "etiqueta" => "Figure 7"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr7.jpeg"
            "Alto" => 1950
            "Ancho" => 2167
            "Tamanyo" => 581677
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0035"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Canthopexy&#46; A&#44; Mixed post-surgical ectropion &#40;involutional and mechanical origin resulting from removal of a graft used for reconstruction after excision of basal cell carcinoma&#41;&#46; B&#44; Release of retractile tissue and an incision of 1&#8239;cm at 0&#46;3 to 0&#46;5&#8239;cm from the outer canthus and dissection until locating the external canthal ligament&#46; C&#44; Fixing the canthal ligament to the internal face of the periosteum of the orbital rim with a single-strand absorbable 5&#47;0 suture&#46;</p>"
        ]
      ]
      7 => array:8 [
        "identificador" => "fig0040"
        "etiqueta" => "Figure 8"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr8.jpeg"
            "Alto" => 1575
            "Ancho" => 2500
            "Tamanyo" => 615108
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0040"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Canthoplasty&#46; A&#44; Postsurgical eversion of the lower eyelid in a 65-year-old woman with moderate-severe horizontal laxity&#46; B&#44; Lateral canthoplasty for eyelid repositioning&#58; horizontal incision of 1&#8239;cm in the anterior lamella through the external canthus&#44; leaving the canthal ligament exposed&#46; Location of the anchoring point that corrects the defect and attachment of the ligament to the periosteum of the internal face of the orbital rim with an absorbable 5&#47;0 suture&#44; at 2&#8239;mm above the internal canthus&#46; C&#44; Skin suture by direct closure with 5&#47;0 silk &#40;<a class="elsevierStyleCrossRef" href="#fig0035">Fig&#46; 7</a>B and C&#41;&#46; D and E&#44; Good functional and esthetic outcome at 8 weeks&#46;</p>"
        ]
      ]
      8 => array:8 [
        "identificador" => "fig0045"
        "etiqueta" => "Figure 9"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr9.jpeg"
            "Alto" => 1929
            "Ancho" => 2500
            "Tamanyo" => 247659
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0045"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Algorithm&#58; surgical corrective techniques for ectropion&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:18 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The evaluation and management of lower eyelid retraction following cosmetic surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "M&#46; Patipa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/00006534-200008000-00033"
                      "Revista" => array:6 [
                        "tituloSerie" => "Plast Reconstr Surg"
                        "fecha" => "2000"
                        "volumen" => "106"
                        "paginaInicial" => "438"
                        "paginaFinal" => "459"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10946945"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lower eyelid anatomy&#58; an update"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "H&#46; Kakizaki"
                            1 => "R&#46; Malhotra"
                            2 => "S&#46;N&#46; Madge"
                            3 => "D&#46; Selva"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/SAP.0b013e31818c4b22"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Plast Surg"
                        "fecha" => "2009"
                        "volumen" => "63"
                        "paginaInicial" => "344"
                        "paginaFinal" => "351"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19602948"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Eyelid reconstruction&#58; the state of the art"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46;H&#46; Verity"
                            1 => "J&#46;R&#46;O&#46; Collin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.moo.0000130577.04818.1c"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Otolaryngol Head Neck Surg"
                        "fecha" => "2004"
                        "volumen" => "12"
                        "paginaInicial" => "344"
                        "paginaFinal" => "348"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15252259"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Correction of entropion and ectropion"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "C&#46; Hintschich"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000131075"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dev Ophthalmol"
                        "fecha" => "2008"
                        "volumen" => "41"
                        "paginaInicial" => "85"
                        "paginaFinal" => "102"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18453763"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Eyelid malposition&#58; lower lid entropion and ectropion"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R&#46; Piskiniene"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Kaunas Lith"
                        "fecha" => "2006"
                        "volumen" => "42"
                        "paginaInicial" => "881"
                        "paginaFinal" => "884"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ectropion and entropion"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "P&#46; Vallabhanath"
                            1 => "S&#46;R&#46; Carter"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/00055735-200010000-00010"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Ophthalmol"
                        "fecha" => "2000"
                        "volumen" => "11"
                        "paginaInicial" => "345"
                        "paginaFinal" => "351"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11148701"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Using a &#34;Mutaf Triangular Flap&#34; for lower eyelid reconstruction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "P&#46; Fern&#225;ndez Canga"
                            1 => "E&#46; Varas Meis"
                            2 => "J&#46; Casti&#241;eiras Gonz&#225;lez"
                            3 => "M&#46; Espasand&#237;n Arias"
                            4 => "M&#46;&#193;&#46; Rodr&#237;guez Prieto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ad.2018.01.011"
                      "Revista" => array:6 [
                        "tituloSerie" => "Actas Dermosifiliogr"
                        "fecha" => "2018"
                        "volumen" => "109"
                        "paginaInicial" => "917"
                        "paginaFinal" => "919"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30268518"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Blepharoplasty basics for the dermatologist"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46; Scawn"
                            1 => "S&#46; Gore"
                            2 => "N&#46; Joshi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Cutan Aesthetic Surg"
                        "fecha" => "2016"
                        "volumen" => "9"
                        "paginaInicial" => "80"
                        "paginaFinal" => "84"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The evaluation and management of lower eyelid retraction following cosmetic surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "M&#46; Patipa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/00006534-200008000-00033"
                      "Revista" => array:6 [
                        "tituloSerie" => "Plast Reconstr Surg"
                        "fecha" => "2000"
                        "volumen" => "106"
                        "paginaInicial" => "438"
                        "paginaFinal" => "453"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10946945"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surgical Pearl&#58; temporary suspension suture &#40;Frost suture&#41; to help prevent ectropion after infraorbital reconstruction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "E&#46;B&#46; Desciak"
                            1 => "Y&#46;D&#46; Eliezri"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s0190-9622(03)02116-9"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "2003"
                        "volumen" => "49"
                        "paginaInicial" => "1107"
                        "paginaFinal" => "1108"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14639392"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lower eyelid splinting&#58; An alternative to the Frost suture"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46; Jothi"
                            1 => "K&#46;S&#46; Moe"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.mlg.0000220153.01740.ef"
                      "Revista" => array:6 [
                        "tituloSerie" => "Laryngoscope"
                        "fecha" => "2007"
                        "volumen" => "117"
                        "paginaInicial" => "63"
                        "paginaFinal" => "66"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17202932"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surgical preferences for lateral canthoplasty and canthopexy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "D&#46; Georgescu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/ICU.0000000000000094"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Ophthalmol"
                        "fecha" => "2014"
                        "volumen" => "25"
                        "paginaInicial" => "449"
                        "paginaFinal" => "454"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25050757"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Age-related medial ectropion of the lower eyelid"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "B&#46; O&#8217;Donnell"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1442-9071.1994.tb01714.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Aust N Z J Ophthalmol"
                        "fecha" => "1994"
                        "volumen" => "22"
                        "paginaInicial" => "183"
                        "paginaFinal" => "186"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7818876"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management of lower lid ectropion"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46; Liebau"
                            1 => "A&#46; Schulz"
                            2 => "A&#46; Arens"
                            3 => "H&#46; Tilkorn"
                            4 => "V&#46; Schwipper"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1524-4725.2006.32229.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Surg"
                        "fecha" => "2006"
                        "volumen" => "32"
                        "paginaInicial" => "1050"
                        "paginaFinal" => "1057"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16918568"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tripier flap for medial lower eyelid reconstruction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "K&#46; Bickle"
                            1 => "R&#46;G&#46; Bennett"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1524-4725.2008.34319.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Surg"
                        "fecha" => "2008"
                        "volumen" => "34"
                        "paginaInicial" => "1545"
                        "paginaFinal" => "1548"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18823352"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Modified Tripier flap in reconstruction of the lower eyelid"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "W&#46;L&#46;G&#46; Machado"
                            1 => "P&#46;C&#46;M&#46; Gurfinkel"
                            2 => "G&#46;V&#46; Gualberto"
                            3 => "F&#46;M&#46;S&#46; Sampaio"
                            4 => "M&#46;L&#46;C&#46; Melo"
                            5 => "C&#46;M&#46; Treu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1590/abd1806-4841.20153373"
                      "Revista" => array:6 [
                        "tituloSerie" => "An Bras Dermatol"
                        "fecha" => "2015"
                        "volumen" => "90"
                        "paginaInicial" => "108"
                        "paginaFinal" => "110"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26312689"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidence of host site complications in periocular full thickness skin grafts"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "I&#46; Leibovitch"
                            1 => "S&#46;C&#46; Huilgol"
                            2 => "J&#46;D&#46; Hsuan"
                            3 => "D&#46; Selva"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bjo.2004.052639"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Ophthalmol"
                        "fecha" => "2005"
                        "volumen" => "89"
                        "paginaInicial" => "219"
                        "paginaFinal" => "222"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15665356"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Eyelid reconstruction with full thickness skin grafts after carcinoma excision"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Z&#46;I&#46; Zlatarova"
                            1 => "B&#46;N&#46; Nenkova"
                            2 => "E&#46;B&#46; Softova"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Folia Med &#40;Plovdiv&#41;"
                        "fecha" => "2016"
                        "volumen" => "58"
                        "paginaInicial" => "42"
                        "paginaFinal" => "47"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/15782190/0000011100000003/v1_202005050702/S1578219020300251/v1_202005050702/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "6151"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Practical Dermatology"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/15782190/0000011100000003/v1_202005050702/S1578219020300251/v1_202005050702/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219020300251?idApp=UINPBA000044"
]
Share
Journal Information

Statistics

Follow this link to access the full text of the article

Practical Dermatology
Ectropion in Dermatologic Surgery: Exploration and Reconstruction Techniques
Ectropión en cirugía dermatológica: exploración y técnicas reconstructivas
P. Fernández Canga
Corresponding author
paulafcanga@gmail.com

Corresponding author.
, E. Varas Meis, J. Castiñeiras González, C. Prada García, M.Á. Rodríguez Prieto
Servicio de Dermatología, Complejo Asistencial Universitario de León, León, Spain
Read
8258
Times
was read the article
2418
Total PDF
5840
Total HTML
Share statistics
 array:25 [
  "pii" => "S1578219020300251"
  "issn" => "15782190"
  "doi" => "10.1016/j.adengl.2020.03.003"
  "estado" => "S300"
  "fechaPublicacion" => "2020-04-01"
  "aid" => "2286"
  "copyright" => "AEDV"
  "copyrightAnyo" => "2019"
  "documento" => "article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "fla"
  "cita" => "Actas Dermosifiliogr. 2020;111:229-35"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:1 [
    "total" => 0
  ]
  "Traduccion" => array:1 [
    "es" => array:20 [
      "pii" => "S0001731019303886"
      "issn" => "00017310"
      "doi" => "10.1016/j.ad.2019.06.004"
      "estado" => "S300"
      "fechaPublicacion" => "2020-04-01"
      "aid" => "2286"
      "copyright" => "AEDV"
      "documento" => "article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "fla"
      "cita" => "Actas Dermosifiliogr. 2020;111:229-35"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:1 [
        "total" => 0
      ]
      "es" => array:14 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">DERMATOLOG&#205;A PR&#193;CTICA</span>"
        "titulo" => "Ectropi&#243;n en cirug&#237;a dermatol&#243;gica&#58; exploraci&#243;n y t&#233;cnicas reconstructivas"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:3 [
          0 => "es"
          1 => "es"
          2 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "229"
            "paginaFinal" => "235"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Ectropion in Dermatologic Surgery&#58; Exploration and Reconstruction Techniques"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 1
          "multimedia" => array:5 [
            "identificador" => "fig0050"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => false
            "mostrarDisplay" => true
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "fx1.jpeg"
                "Alto" => 895
                "Ancho" => 1333
                "Tamanyo" => 69100
              ]
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "P&#46; Fern&#225;ndez Canga, E&#46; Varas Meis, J&#46; Casti&#241;eiras Gonz&#225;lez, C&#46; Prada Garc&#237;a, M&#46;&#193;&#46; Rodr&#237;guez Prieto"
            "autores" => array:5 [
              0 => array:2 [
                "nombre" => "P&#46;"
                "apellidos" => "Fern&#225;ndez Canga"
              ]
              1 => array:2 [
                "nombre" => "E&#46;"
                "apellidos" => "Varas Meis"
              ]
              2 => array:2 [
                "nombre" => "J&#46;"
                "apellidos" => "Casti&#241;eiras Gonz&#225;lez"
              ]
              3 => array:2 [
                "nombre" => "C&#46;"
                "apellidos" => "Prada Garc&#237;a"
              ]
              4 => array:2 [
                "nombre" => "M&#46;&#193;&#46;"
                "apellidos" => "Rodr&#237;guez Prieto"
              ]
            ]
          ]
        ]
        "resumen" => array:1 [
          0 => array:3 [
            "titulo" => "Graphical abstract"
            "clase" => "graphical"
            "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><elsevierMultimedia ident="fig0050"></elsevierMultimedia></p></span>"
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S1578219020300251"
          "doi" => "10.1016/j.adengl.2020.03.003"
          "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/S1578219020300251?idApp=UINPBA000044"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731019303886?idApp=UINPBA000044"
      "url" => "/00017310/0000011100000003/v3_202009190646/S0001731019303886/v3_202009190646/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:20 [
    "pii" => "S1578219020300378"
    "issn" => "15782190"
    "doi" => "10.1016/j.adengl.2020.03.010"
    "estado" => "S300"
    "fechaPublicacion" => "2020-04-01"
    "aid" => "2285"
    "copyright" => "AEDV"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "ssu"
    "cita" => "Actas Dermosifiliogr. 2020;111:236-42"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Novelties in Dermatology</span>"
      "titulo" => "Ex Vivo Confocal Microscopy Using Fusion Mode and Digital Staining&#58; Changing Paradigms in Histological Diagnosis"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "236"
          "paginaFinal" => "242"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Microscopia confocal <span class="elsevierStyleItalic">ex vivo</span> con m&#233;todo de fusi&#243;n y tinci&#243;n digital&#58; cambiando paradigmas en el diagn&#243;stico histol&#243;gico"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig0010"
          "etiqueta" => "Figure 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 1236
              "Ancho" => 2500
              "Tamanyo" => 584995
            ]
          ]
          "detalles" => array:1 [
            0 => array:3 [
              "identificador" => "at0010"
              "detalle" => "Figure "
              "rol" => "short"
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Image of normal skin in different modes&#58; A&#44; fluorescence&#59; B&#44; reflectance&#59; C&#44; fusion&#59; D&#44; digital hematoxylin&#8211;eosin&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "J P&#233;rez-Anker, J Malvehy, D Moreno-Ram&#237;rez"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "J"
              "apellidos" => "P&#233;rez-Anker"
            ]
            1 => array:2 [
              "nombre" => "J"
              "apellidos" => "Malvehy"
            ]
            2 => array:2 [
              "nombre" => "D"
              "apellidos" => "Moreno-Ram&#237;rez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0001731019303874"
        "doi" => "10.1016/j.ad.2019.05.005"
        "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/S0001731019303874?idApp=UINPBA000044"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219020300378?idApp=UINPBA000044"
    "url" => "/15782190/0000011100000003/v1_202005050702/S1578219020300378/v1_202005050702/en/main.assets"
  ]
  "itemAnterior" => array:20 [
    "pii" => "S1578219020300329"
    "issn" => "15782190"
    "doi" => "10.1016/j.adengl.2020.03.008"
    "estado" => "S300"
    "fechaPublicacion" => "2020-04-01"
    "aid" => "2289"
    "copyright" => "AEDV"
    "documento" => "simple-article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "pgl"
    "cita" => "Actas Dermosifiliogr. 2020;111:222-8"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Consensus Document</span>"
      "titulo" => "A Review of the Latest Recommendations on the Management of Chronic Urticaria&#58; A Multidisciplinary Consensus Statement From Andalusia&#44; Spain"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "222"
          "paginaFinal" => "228"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Revisi&#243;n de las &#250;ltimas novedades en el manejo del paciente con urticaria cr&#243;nica&#58; Consenso multidisciplinar de la comunidad aut&#243;noma de Andaluc&#237;a"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 522
              "Ancho" => 1508
              "Tamanyo" => 37170
            ]
          ]
          "detalles" => array:1 [
            0 => array:3 [
              "identificador" => "at0005"
              "detalle" => "Figure "
              "rol" => "short"
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Association between Urticaria Activity Score 7 &#40;UAS7&#41;&#44; disease control&#44; and changes to treatment&#46; The experts agreed that a UAS7 score of over 7 indicates poor disease control and that the patient should be switched to another treatment&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "M&#46; Alc&#225;ntara Villar, J&#46;C&#46; Armario Hita, S&#46; Cimbollek, M&#46;D&#46; Fern&#225;ndez Ballesteros, M&#46; Gal&#225;n Guti&#233;rrez, C&#46; Hern&#225;ndez Montoya, M&#46;&#193;&#46; Lara-Jim&#233;nez, J&#46;J&#46; Pereyra Rodr&#237;guez, J&#46;M&#46; Vega Chicote, R&#46; Ruiz-Villaverde"
          "autores" => array:10 [
            0 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Alc&#225;ntara Villar"
            ]
            1 => array:2 [
              "nombre" => "J&#46;C&#46;"
              "apellidos" => "Armario Hita"
            ]
            2 => array:2 [
              "nombre" => "S&#46;"
              "apellidos" => "Cimbollek"
            ]
            3 => array:2 [
              "nombre" => "M&#46;D&#46;"
              "apellidos" => "Fern&#225;ndez Ballesteros"
            ]
            4 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Gal&#225;n Guti&#233;rrez"
            ]
            5 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Hern&#225;ndez Montoya"
            ]
            6 => array:2 [
              "nombre" => "M&#46;&#193;&#46;"
              "apellidos" => "Lara-Jim&#233;nez"
            ]
            7 => array:2 [
              "nombre" => "J&#46;J&#46;"
              "apellidos" => "Pereyra Rodr&#237;guez"
            ]
            8 => array:2 [
              "nombre" => "J&#46;M&#46;"
              "apellidos" => "Vega Chicote"
            ]
            9 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "Ruiz-Villaverde"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0001731019303916"
        "doi" => "10.1016/j.ad.2019.04.009"
        "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/S0001731019303916?idApp=UINPBA000044"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219020300329?idApp=UINPBA000044"
    "url" => "/15782190/0000011100000003/v1_202005050702/S1578219020300329/v1_202005050702/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Practical Dermatology</span>"
    "titulo" => "Ectropion in Dermatologic Surgery&#58; Exploration and Reconstruction Techniques"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "229"
        "paginaFinal" => "235"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "P&#46; Fern&#225;ndez Canga, E&#46; Varas Meis, J&#46; Casti&#241;eiras Gonz&#225;lez, C&#46; Prada Garc&#237;a, M&#46;&#193;&#46; Rodr&#237;guez Prieto"
        "autores" => array:5 [
          0 => array:4 [
            "nombre" => "P&#46;"
            "apellidos" => "Fern&#225;ndez Canga"
            "email" => array:1 [
              0 => "paulafcanga@gmail.com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "&#42;"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:2 [
            "nombre" => "E&#46;"
            "apellidos" => "Varas Meis"
          ]
          2 => array:2 [
            "nombre" => "J&#46;"
            "apellidos" => "Casti&#241;eiras Gonz&#225;lez"
          ]
          3 => array:2 [
            "nombre" => "C&#46;"
            "apellidos" => "Prada Garc&#237;a"
          ]
          4 => array:2 [
            "nombre" => "M&#46;&#193;&#46;"
            "apellidos" => "Rodr&#237;guez Prieto"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Servicio de Dermatolog&#237;a&#44; Complejo Asistencial Universitario de Le&#243;n&#44; Le&#243;n&#44; Spain"
            "identificador" => "aff0005"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Ectropi&#243;n en cirug&#237;a dermatol&#243;gica&#58; exploraci&#243;n y t&#233;cnicas reconstructivas"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:8 [
        "identificador" => "fig0040"
        "etiqueta" => "Figure 8"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr8.jpeg"
            "Alto" => 1575
            "Ancho" => 2500
            "Tamanyo" => 615108
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0040"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Canthoplasty&#46; A&#44; Postsurgical eversion of the lower eyelid in a 65-year-old woman with moderate-severe horizontal laxity&#46; B&#44; Lateral canthoplasty for eyelid repositioning&#58; horizontal incision of 1&#8239;cm in the anterior lamella through the external canthus&#44; leaving the canthal ligament exposed&#46; Location of the anchoring point that corrects the defect and attachment of the ligament to the periosteum of the internal face of the orbital rim with an absorbable 5&#47;0 suture&#44; at 2&#8239;mm above the internal canthus&#46; C&#44; Skin suture by direct closure with 5&#47;0 silk &#40;<a class="elsevierStyleCrossRef" href="#fig0035">Fig&#46; 7</a>B and C&#41;&#46; D and E&#44; Good functional and esthetic outcome at 8 weeks&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The lower eyelid is subdivided into the anterior lamella &#40;skin and orbicularis oculi muscle&#41;&#44; medial lamella &#40;orbital septum&#44; orbital fat&#41;&#44; and the posterior lamella &#40;capsulopalpebral fascia&#44; tarsus&#44; and conjunctiva&#41;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; In its physiological position&#44; it has a protective function and participates in tear film homeostasis&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a> The free border of the lower eyelid should be level with the corneal limbus&#46; The eyelid is kept in this position by the following supporting structures&#58; medial and lateral canthal tendons&#44; the elements comprising the medial lamella&#44; and the posterior lamellar retractors &#40;capsulopalpebral fascia&#44; Lockwood ligament&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Ectropion occurs on eversion of the eyelid&#44; such that the internal surface is exposed&#44; potentially giving rise to epiphora&#44; lagophthalmos&#44; chronic irritation&#44; keratitis&#44; pain&#44; and ulceration&#46; Ectropion is the most frequent eyelid malposition&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">There are 5 types of ectropion&#58; congenital&#44; paralytic&#44; involutional&#44; cicatricial&#44; and mechanical&#46; Congenital ectropion is extremely rare and usually occurs due to vertical skin foreshortening in blepharophimosis syndrome&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2&#44;6</span></a> Paralytic ectropion is caused by paresis of the orbicularis oculi muscle&#44; generally as a result of facial nerve paralysis&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> Involutional or senile ectropion is the most frequent type&#44;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a> and is caused by laxity&#44; atrophy&#44; or disinsertion of the supporting structures &#40;tarsus&#44; orbital septum&#44; ligaments&#44; canthal tendons&#44; and retractors&#41;&#44; and loss of elasticity and decreased orbital and malar fat&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> Cicatricial and mechanical ectropion are due to a vertical vector that exerts a tractional force on the eyelid&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In cicatricial ectropion&#44; the most frequent cause is foreshortening of the anterior lamella due to mechanical&#44; chemical&#44; or thermal damage or postoperative cicatricial retractions&#46; The most common causes of mechanical ectropion include periorbital edema and tumors&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Periorbital tumors&#44; in addition to causing mechanical ectropion&#44; may indirectly give rise to cicatricial ectropion through reconstruction with excessive vertical tightening after excision&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Examination Techniques</span><p id="par0025" class="elsevierStylePara elsevierViewall">Appropriate eyelid examination should be conducted prior to all types of periocular surgery&#46; This will determine the risk of postoperative ectropion and enable compensatory elements to be included when planning the operation&#46; When ectropion is already present&#44; examination will serve to determine the predominant pathogenic component and enable the most appropriate repair technique to be chosen&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">There are 4 simple tests to determine eyelid laxity&#44; the snap back test and the vertical&#44; lateral&#44; and medial distraction tests &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Pulling the lower eyelid can evidence excessive laxity if there is a delay in the eyelid returning to its original position &#40;snap back test&#41; or if the eyelid separates more than 8&#8239;mm from the eyeball &#40;vertical distraction test&#41;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>a&#41;&#46; Medial distraction would reveal lateral canthal hyperlaxity in the event that the outer corner of the eye extends more than 2&#8239;mm &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>b&#41; and&#44; finally&#44; lateral distraction would show hyperlaxity of the medial canthus if the lacrimal punctum is pulled than 2&#8239;mm<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>c&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The predominant elements in the above tests would allow the most appropriate preventive or corrective surgical technique to be chosen&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Surgical Techniques to Prevent Ectropion</span><p id="par0040" class="elsevierStylePara elsevierViewall">Excessive eyelid laxity is common in elderly individuals&#44; with tumors being the most common underlying cause&#46; Thus&#44; when planning surgery for a tumor in the lower eyelid in patients with excessive eyelid laxity&#44; reduction of the horizontal component or inclusion of corrective techniques should be contemplated&#44; ideally at the same time as surgery&#44; in order to prevent the onset of postoperative ectropion&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The Frost suspension suture&#44; described in 1934&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> aims to bring the lower eyelid to its anatomical position in the immediate postoperative period&#46; The technique consists of anchoring the inferior tarsus temporarily with a nonabsorbable suture that is fixed to the supraciliary space by simply stitches or with adhesive strips &#40;enabling retightening during the healing process&#41;&#46; This technique can prevent the formation of postoperative ectropion due to edema formation or hemorrhage in the immediate postoperative period&#46; If the suture is centrally positioned&#44; the eye should be kept occluded due to the risk of corneal abrasion and there is a risk of skin erosion with excessive tightening&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">A tumor excision pattern in wedge or pentagonal form<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> can shorten the lower eyelid at the same time as the tumor is removed&#44; thereby achieving both the oncological and reconstructive goal&#44; and avoiding ectropion &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Repositioning of the central canthus is a key compensatory element that should be associated with any reconstructive procedure in the lower eyelid to help prevent ectropion formation&#46; Two surgical techniques that can prevent or correct eyelid eversion by canthal repositioning are canthopexy and canthoplasty&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a> shows the techniques that aim to prevent the formation of ectropion by cause&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Surgical Techniques for Ectropion Correction</span><p id="par0065" class="elsevierStylePara elsevierViewall">The aim of repair of cicatricial or mechanical ectropion is to eliminate cause of the tractional element&#46; This is achieved using a Z-plasty or excising the lesion that is responsible for the vertical tensile force on the lower eyelid &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Ectropion resulting from loss of volume can be corrected by providing tissue in the form of a flap or graft&#44; or with synthetic materials&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;9&#44;14</span></a> One of the most widely used flaps is the Tripier flap&#44; in which skin and muscle are taken from the upper eyelid &#40;<a class="elsevierStyleCrossRef" href="#fig0030">Fig&#46; 6</a>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;16</span></a> In the case of grafting&#44; the most appropriate areas for donor skin are the upper eyelid and the preauricular and retroauricular region&#44; as the skin in those regions has a similar thickness and texture&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;6&#44;17&#44;18</span></a> Finally&#44; synthetic materials are a valid alternative to autologous grafts&#44; although they are less widely used given their high cost and greater risk of contraction&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><elsevierMultimedia ident="fig0030"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Treatment of postoperative ectropion in patients with eyelid laxity &#40;involutional component&#41; aims to achieve horizontal tightening&#46; This is achieved by repositioning of the lateral canthus by canthopexy or cantoplasty&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Canthopexy aims to tighten the lateral canthal tendon by attaching it to the lateral orbital rim without the need for canthotomy &#40;incision and extension of the medial canthus&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0035">Fig&#46; 7</a>&#41;&#46; This is used in cases of mild hyperlaxity&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> In contrast&#44; canthoplasty is used to correct more severe hyperlaxities and requires canthotomy before anchoring the outer canthus &#40;<a class="elsevierStyleCrossRef" href="#fig0040">Fig&#46; 8</a>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;4&#44;6&#44;12</span></a> One of the most widely used canthoplasty procedures is the tarsal strip in which the free border of the inferior tarsus is released and deepithelialized to form a strip that is subsequently anchored to the orbital rim to form a neocanthus&#46; The anchor point for the canthal repositioning is level with the periosteum&#44; in the internal face of the lateral orbital rim&#44; 2&#8239;mm above the medial canthus&#44; so that the tears follow a superolateral or inferomedial pathway and can provide appropriate lubrication&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><elsevierMultimedia ident="fig0035"></elsevierMultimedia><elsevierMultimedia ident="fig0040"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Correction of severe ectropion&#44; in which postoperative retraction is combined with excessive eyelid laxity&#44; may require a combination of the 2 techniques&#44; that is&#44; elimination of the cicatricial component and canthal repositioning&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0045">Fig&#46; 9</a> shows the surgical techniques for repairing ectropion by cause&#46;</p><elsevierMultimedia ident="fig0045"></elsevierMultimedia></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conclusion</span><p id="par0090" class="elsevierStylePara elsevierViewall">Knowledge of basic eyelid anatomy and adequate preoperative examination will enable the dermatologic surgeon to design the most effective surgical procedures to avoid ectropion&#44; or&#44; if applicable&#44; choose the best type of repair surgery according to the predominant causal component&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conflicts of interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:9 [
        0 => array:3 [
          "identificador" => "xres1332891"
          "titulo" => "Abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0005"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1227998"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres1332892"
          "titulo" => "Resumen"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0010"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1227997"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Examination Techniques"
          "secciones" => array:2 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Surgical Techniques to Prevent Ectropion"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Surgical Techniques for Ectropion Correction"
            ]
          ]
        ]
        6 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Conclusion"
        ]
        7 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Conflicts of interest"
        ]
        8 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2019-01-09"
    "fechaAceptado" => "2019-06-11"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1227998"
          "palabras" => array:5 [
            0 => "Ectropion"
            1 => "Surgical reconstruction procedures"
            2 => "Dermatologic surgical procedures"
            3 => "Skin surgery"
            4 => "Cosmetic techniques"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1227997"
          "palabras" => array:5 [
            0 => "Ectropion"
            1 => "Procedimientos quir&#250;rgicos reconstructivos"
            2 => "Procedimientos dermatol&#243;gicos quir&#250;rgicos"
            3 => "Cirug&#237;a cut&#225;nea"
            4 => "T&#233;cnicas cosm&#233;ticas"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Ectropion&#44; or eyelid eversion&#44; is the most common form of eyelid malposition&#46; By impairing the eyelid&#8217;s protective function&#44; ectropion can cause epiphora&#44; lagophthalmos&#44; keratinization&#44; chronic irritation&#44; pain&#44; and ulceration&#46; There are 5 types of ectropion&#44; each with a different cause&#58; congenital&#44; paralytic&#44; involutional&#44; cicatricial&#44; and mechanical&#46; The most common presentation in dermatology is involutional eversion with a mechanical or tractional element&#46; Several options exist for the surgical repair of ectropion and choice of technique will depend on the main pathogenic component&#46; We review the basic anatomy of the eyelid and describe examination techniques for assessing risk and preventing ectropion and for identifying the main pathogenic component in order to select the most suitable repair technique&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">El ectropion o eversi&#243;n del p&#225;rpado&#44; es la malposici&#243;n palpebral m&#225;s frecuente&#46; Al alterar la funci&#243;n protectora palpebral puede causar ep&#237;fora&#44; lagoftalmos&#44; queratinizaci&#243;n&#44; irritaci&#243;n cr&#243;nica&#44; dolor o ulceraci&#243;n&#46; Se distinguen 5 tipos de ectropion en funci&#243;n de su mecanismo causal&#58; cong&#233;nito&#44; paral&#237;tico&#44; involutivo&#44; cicatricial y mec&#225;nico&#46; Lo m&#225;s habitual en dermatolog&#237;a&#44; es la presencia de ectropi&#243;n de tipo mixto&#44; con elementos involutivos y mec&#225;nico-traccionales&#46; Existen varias t&#233;cnicas reparadoras de ectropion cuya indicaci&#243;n depender&#225; del componente patog&#233;nico principal&#46; Revisamos la anatom&#237;a b&#225;sica palpebral y exponemos la t&#233;cnica exploratoria que nos permitir&#225; analizar el riesgo de ectropion para prevenir su aparici&#243;n o determinar la patogenia del ectropi&#243;n ya establecido para definir la t&#233;cnica reparadora m&#225;s apropiada&#46;</p></span>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Fern&#225;ndez Canga P&#44; Varas Meis E&#44; Casti&#241;eiras Gonz&#225;lez J&#44; Prada Garc&#237;a C&#44; Rodr&#237;guez Prieto M&#193;&#46; Ectropi&#243;n en cirug&#237;a dermatol&#243;gica&#58; exploraci&#243;n y t&#233;cnicas reconstructivas&#46; Actas Dermosifiliogr&#46; 2020&#59;111&#58;229&#8211;235&#46;</p>"
      ]
    ]
    "multimedia" => array:9 [
      0 => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1006
            "Ancho" => 1500
            "Tamanyo" => 89623
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Basic eyelid anatomy&#46; Anterior lamella &#40;skin and orbicularis oculi muscle&#41;&#44; medial lamella &#40;orbital septum and orbital fat&#41;&#44; and posterior lamella &#40;capsulopalpebral fascia&#44; tarsus&#44; and conjunctiva&#41;&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 623
            "Ancho" => 2500
            "Tamanyo" => 155425
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0010"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Examination techniques&#46; A&#44; Snap back test and vertical distraction test&#58; excessive laxity is observed if there is a delay in the eyelid returning to its original position or if the eyelid separates more than 8&#8239;mm from the eyeball with vertical pulling&#44; respectively&#46; B&#44; Medial distraction test&#58; lateral canthal hyperlaxity if the outer corner of the eye can be pulled more than 2&#8239;mm&#46; C&#44; Lateral distraction test&#58; hyperlaxity of the medial canthus if the lacrimal punctum moves more than 2&#8239;mm&#46; Source&#58; Fern&#225;ndez-Canga et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1607
            "Ancho" => 2500
            "Tamanyo" => 598768
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0015"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Pentagonal excision&#46; A&#44; Basal cell carcinoma in the lower right eyelid in an 85-year-old male patient with mixed ectropion &#40;involutional and mechanical caused by the tumor&#41;&#46; B and C&#44; Pentagonal tumor resection was designed to achieve the oncological objective as well as the reconstructive one&#44; by avoiding ectropion with a reduction in the horizontal component of the eyelid&#46; Outcome of the technique immediately after the procedure &#40;D&#41; and at 8 weeks &#40;E&#41;&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "fig0020"
        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 1209
            "Ancho" => 2500
            "Tamanyo" => 180563
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0020"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Algorithm for preventive surgical techniques for ectropion&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "fig0025"
        "etiqueta" => "Figure 5"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr5.jpeg"
            "Alto" => 1474
            "Ancho" => 2500
            "Tamanyo" => 729576
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0025"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Z-plasty&#46; A&#44; 54-year-old patient with spindle-cell carcinoma in the infraorbital region&#46; B&#44; Surgical defect and reconstruction design with a glabellar and cheek combined flap&#46; C&#44; Multicomponent&#44; severe postoperative ectropion&#44; with cicatricial elements&#44; loss of volume and involution&#46; Symptoms of lagophthalmos and accompanying conjunctival hemorrhage&#46; D and E&#44; For correction&#44; the vertical cicatricial tensile force was released by Z-plasty&#46; F&#44; Late postoperative outcome &#40;at 8 weeks&#41;&#58; repositioning of the lower eyelid&#46;</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "fig0030"
        "etiqueta" => "Figure 6"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr6.jpeg"
            "Alto" => 1293
            "Ancho" => 2500
            "Tamanyo" => 562520
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0030"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Tripier flap&#46; A&#44; Tractional postoperative ectropion with lack of volume in the lower eyelid&#46; B&#44; Design of a transposition flap from the upper eyelid or Tripier flap&#46; C&#44; Final positioning of the flap after making an incision immediately below the eyelash line in the lower eyelid&#44; dissection and transposition of the flap&#46; D&#44; Immediate postoperative outcome&#46; E and F&#44; Late postoperative outcome at 8 weeks&#46;</p>"
        ]
      ]
      6 => array:8 [
        "identificador" => "fig0035"
        "etiqueta" => "Figure 7"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr7.jpeg"
            "Alto" => 1950
            "Ancho" => 2167
            "Tamanyo" => 581677
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0035"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Canthopexy&#46; A&#44; Mixed post-surgical ectropion &#40;involutional and mechanical origin resulting from removal of a graft used for reconstruction after excision of basal cell carcinoma&#41;&#46; B&#44; Release of retractile tissue and an incision of 1&#8239;cm at 0&#46;3 to 0&#46;5&#8239;cm from the outer canthus and dissection until locating the external canthal ligament&#46; C&#44; Fixing the canthal ligament to the internal face of the periosteum of the orbital rim with a single-strand absorbable 5&#47;0 suture&#46;</p>"
        ]
      ]
      7 => array:8 [
        "identificador" => "fig0040"
        "etiqueta" => "Figure 8"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr8.jpeg"
            "Alto" => 1575
            "Ancho" => 2500
            "Tamanyo" => 615108
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0040"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Canthoplasty&#46; A&#44; Postsurgical eversion of the lower eyelid in a 65-year-old woman with moderate-severe horizontal laxity&#46; B&#44; Lateral canthoplasty for eyelid repositioning&#58; horizontal incision of 1&#8239;cm in the anterior lamella through the external canthus&#44; leaving the canthal ligament exposed&#46; Location of the anchoring point that corrects the defect and attachment of the ligament to the periosteum of the internal face of the orbital rim with an absorbable 5&#47;0 suture&#44; at 2&#8239;mm above the internal canthus&#46; C&#44; Skin suture by direct closure with 5&#47;0 silk &#40;<a class="elsevierStyleCrossRef" href="#fig0035">Fig&#46; 7</a>B and C&#41;&#46; D and E&#44; Good functional and esthetic outcome at 8 weeks&#46;</p>"
        ]
      ]
      8 => array:8 [
        "identificador" => "fig0045"
        "etiqueta" => "Figure 9"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr9.jpeg"
            "Alto" => 1929
            "Ancho" => 2500
            "Tamanyo" => 247659
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0045"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Algorithm&#58; surgical corrective techniques for ectropion&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:18 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The evaluation and management of lower eyelid retraction following cosmetic surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "M&#46; Patipa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/00006534-200008000-00033"
                      "Revista" => array:6 [
                        "tituloSerie" => "Plast Reconstr Surg"
                        "fecha" => "2000"
                        "volumen" => "106"
                        "paginaInicial" => "438"
                        "paginaFinal" => "459"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10946945"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lower eyelid anatomy&#58; an update"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "H&#46; Kakizaki"
                            1 => "R&#46; Malhotra"
                            2 => "S&#46;N&#46; Madge"
                            3 => "D&#46; Selva"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/SAP.0b013e31818c4b22"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Plast Surg"
                        "fecha" => "2009"
                        "volumen" => "63"
                        "paginaInicial" => "344"
                        "paginaFinal" => "351"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19602948"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Eyelid reconstruction&#58; the state of the art"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46;H&#46; Verity"
                            1 => "J&#46;R&#46;O&#46; Collin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.moo.0000130577.04818.1c"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Otolaryngol Head Neck Surg"
                        "fecha" => "2004"
                        "volumen" => "12"
                        "paginaInicial" => "344"
                        "paginaFinal" => "348"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15252259"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Correction of entropion and ectropion"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "C&#46; Hintschich"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000131075"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dev Ophthalmol"
                        "fecha" => "2008"
                        "volumen" => "41"
                        "paginaInicial" => "85"
                        "paginaFinal" => "102"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18453763"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Eyelid malposition&#58; lower lid entropion and ectropion"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R&#46; Piskiniene"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Kaunas Lith"
                        "fecha" => "2006"
                        "volumen" => "42"
                        "paginaInicial" => "881"
                        "paginaFinal" => "884"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ectropion and entropion"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "P&#46; Vallabhanath"
                            1 => "S&#46;R&#46; Carter"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/00055735-200010000-00010"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Ophthalmol"
                        "fecha" => "2000"
                        "volumen" => "11"
                        "paginaInicial" => "345"
                        "paginaFinal" => "351"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11148701"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Using a &#34;Mutaf Triangular Flap&#34; for lower eyelid reconstruction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "P&#46; Fern&#225;ndez Canga"
                            1 => "E&#46; Varas Meis"
                            2 => "J&#46; Casti&#241;eiras Gonz&#225;lez"
                            3 => "M&#46; Espasand&#237;n Arias"
                            4 => "M&#46;&#193;&#46; Rodr&#237;guez Prieto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ad.2018.01.011"
                      "Revista" => array:6 [
                        "tituloSerie" => "Actas Dermosifiliogr"
                        "fecha" => "2018"
                        "volumen" => "109"
                        "paginaInicial" => "917"
                        "paginaFinal" => "919"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30268518"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Blepharoplasty basics for the dermatologist"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46; Scawn"
                            1 => "S&#46; Gore"
                            2 => "N&#46; Joshi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Cutan Aesthetic Surg"
                        "fecha" => "2016"
                        "volumen" => "9"
                        "paginaInicial" => "80"
                        "paginaFinal" => "84"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The evaluation and management of lower eyelid retraction following cosmetic surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "M&#46; Patipa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/00006534-200008000-00033"
                      "Revista" => array:6 [
                        "tituloSerie" => "Plast Reconstr Surg"
                        "fecha" => "2000"
                        "volumen" => "106"
                        "paginaInicial" => "438"
                        "paginaFinal" => "453"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10946945"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surgical Pearl&#58; temporary suspension suture &#40;Frost suture&#41; to help prevent ectropion after infraorbital reconstruction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "E&#46;B&#46; Desciak"
                            1 => "Y&#46;D&#46; Eliezri"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s0190-9622(03)02116-9"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "2003"
                        "volumen" => "49"
                        "paginaInicial" => "1107"
                        "paginaFinal" => "1108"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14639392"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lower eyelid splinting&#58; An alternative to the Frost suture"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46; Jothi"
                            1 => "K&#46;S&#46; Moe"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.mlg.0000220153.01740.ef"
                      "Revista" => array:6 [
                        "tituloSerie" => "Laryngoscope"
                        "fecha" => "2007"
                        "volumen" => "117"
                        "paginaInicial" => "63"
                        "paginaFinal" => "66"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17202932"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surgical preferences for lateral canthoplasty and canthopexy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "D&#46; Georgescu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/ICU.0000000000000094"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Ophthalmol"
                        "fecha" => "2014"
                        "volumen" => "25"
                        "paginaInicial" => "449"
                        "paginaFinal" => "454"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25050757"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Age-related medial ectropion of the lower eyelid"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "B&#46; O&#8217;Donnell"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1442-9071.1994.tb01714.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Aust N Z J Ophthalmol"
                        "fecha" => "1994"
                        "volumen" => "22"
                        "paginaInicial" => "183"
                        "paginaFinal" => "186"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7818876"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management of lower lid ectropion"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46; Liebau"
                            1 => "A&#46; Schulz"
                            2 => "A&#46; Arens"
                            3 => "H&#46; Tilkorn"
                            4 => "V&#46; Schwipper"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1524-4725.2006.32229.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Surg"
                        "fecha" => "2006"
                        "volumen" => "32"
                        "paginaInicial" => "1050"
                        "paginaFinal" => "1057"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16918568"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tripier flap for medial lower eyelid reconstruction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "K&#46; Bickle"
                            1 => "R&#46;G&#46; Bennett"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1524-4725.2008.34319.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Surg"
                        "fecha" => "2008"
                        "volumen" => "34"
                        "paginaInicial" => "1545"
                        "paginaFinal" => "1548"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18823352"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Modified Tripier flap in reconstruction of the lower eyelid"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "W&#46;L&#46;G&#46; Machado"
                            1 => "P&#46;C&#46;M&#46; Gurfinkel"
                            2 => "G&#46;V&#46; Gualberto"
                            3 => "F&#46;M&#46;S&#46; Sampaio"
                            4 => "M&#46;L&#46;C&#46; Melo"
                            5 => "C&#46;M&#46; Treu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1590/abd1806-4841.20153373"
                      "Revista" => array:6 [
                        "tituloSerie" => "An Bras Dermatol"
                        "fecha" => "2015"
                        "volumen" => "90"
                        "paginaInicial" => "108"
                        "paginaFinal" => "110"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26312689"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidence of host site complications in periocular full thickness skin grafts"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "I&#46; Leibovitch"
                            1 => "S&#46;C&#46; Huilgol"
                            2 => "J&#46;D&#46; Hsuan"
                            3 => "D&#46; Selva"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bjo.2004.052639"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Ophthalmol"
                        "fecha" => "2005"
                        "volumen" => "89"
                        "paginaInicial" => "219"
                        "paginaFinal" => "222"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15665356"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Eyelid reconstruction with full thickness skin grafts after carcinoma excision"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Z&#46;I&#46; Zlatarova"
                            1 => "B&#46;N&#46; Nenkova"
                            2 => "E&#46;B&#46; Softova"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Folia Med &#40;Plovdiv&#41;"
                        "fecha" => "2016"
                        "volumen" => "58"
                        "paginaInicial" => "42"
                        "paginaFinal" => "47"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/15782190/0000011100000003/v1_202005050702/S1578219020300251/v1_202005050702/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "6151"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Practical Dermatology"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/15782190/0000011100000003/v1_202005050702/S1578219020300251/v1_202005050702/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219020300251?idApp=UINPBA000044"
]
Article information
ISSN: 15782190
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 20 8 28
2024 October 157 47 204
2024 September 130 42 172
2024 August 148 66 214
2024 July 127 54 181
2024 June 108 58 166
2024 May 134 52 186
2024 April 119 50 169
2024 March 128 46 174
2024 February 160 51 211
2024 January 197 56 253
2023 December 128 43 171
2023 November 146 53 199
2023 October 119 38 157
2023 September 106 40 146
2023 August 98 43 141
2023 July 127 64 191
2023 June 98 38 136
2023 May 188 57 245
2023 April 160 42 202
2023 March 218 49 267
2023 February 172 40 212
2023 January 145 43 188
2022 December 124 44 168
2022 November 75 51 126
2022 October 80 36 116
2022 September 92 51 143
2022 August 70 45 115
2022 July 40 45 85
2022 June 30 42 72
2022 May 181 34 215
2022 April 172 43 215
2022 March 118 53 171
2022 February 90 47 137
2022 January 164 91 255
2021 December 128 46 174
2021 November 86 50 136
2021 October 109 56 165
2021 September 91 50 141
2021 August 98 53 151
2021 July 66 25 91
2021 June 72 33 105
2021 May 70 55 125
2021 April 162 98 260
2021 March 84 48 132
2021 February 73 28 101
2021 January 63 19 82
2020 December 54 24 78
2020 November 64 21 85
2020 October 37 17 54
2020 September 38 19 57
2020 August 29 17 46
2020 July 17 10 27
2020 June 37 38 75
2020 May 58 35 93
2020 April 35 14 49
Show all

Follow this link to access the full text of the article

Idiomas
Actas Dermo-Sifiliográficas
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?