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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">Los tumores malignos subungueales &#40;TMSU&#41;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">1</span></a>&#44; representados sobre todo por el carcinoma epidermoide subungueal &#40;CESU&#41; y el melanoma subungueal &#40;MSU&#41;&#44; son una patolog&#237;a poco frecuente&#44; en la cual el diagn&#243;stico temprano y manejo quir&#250;rgico adecuado es fundamental&#46; De forma cl&#225;sica&#44; los dermat&#243;logos han derivado estos tumores a traumat&#243;logos o cirujanos pl&#225;sticos para una amputaci&#243;n m&#225;s o menos agresiva<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">2</span></a>&#44; con un buen control local a costa de un defecto funcional y cosm&#233;tico importante&#44; especialmente para lesiones en las manos&#46; Sin embargo&#44; desde hace poco m&#225;s de 10 a&#241;os<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">3&#44;4</span></a>&#44; la cirug&#237;a local con m&#225;rgenes amplios o cirug&#237;a funcional del aparato ungueal &#40;CFAU&#41; se ha posicionado como una alternativa quir&#250;rgica a la amputaci&#243;n&#44; que puede ser eficaz en el manejo de los TMSU no invasivos&#44; e incluso en tumores de mayor grosor sin otros signos de mal pron&#243;stico<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">5</span></a>&#46; Esta t&#233;cnica permite preservar con mejores resultados est&#233;ticos<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">6</span></a> la funci&#243;n de la falange distal comprometida&#44; sin modificar el pron&#243;stico con respecto a la cirug&#237;a cl&#225;sica de amputaci&#243;n&#46; El objetivo de este trabajo es presentar nuestra serie de TMSU que desde 2008 manejamos con CFAU&#44; describir la t&#233;cnica quir&#250;rgica y revisar sus indicaciones&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Material y m&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Pacientes</span><p id="par0010" class="elsevierStylePara elsevierViewall">Se realiz&#243; un estudio observacional retrospectivo sobre el manejo quir&#250;rgico de los pacientes diagnosticados de TMSU en el Servicio de Dermatolog&#237;a del Hospital General Universitario de Ciudad Real &#40;HGUCR&#41; en los &#250;ltimos 10 a&#241;os &#40;julio de 2008 a junio de 2017&#41;&#46; Se analizaron variables demogr&#225;ficas&#44; cl&#237;nicas e histopatol&#243;gicas&#44; estadificaci&#243;n inicial y evoluci&#243;n de los pacientes&#44; con identificaci&#243;n de recurrencias&#44; met&#225;stasis y mortalidad&#46; Se dise&#241;&#243; una encuesta para completar la informaci&#243;n sobre complicaciones de la cirug&#237;a no reflejadas en la historia cl&#237;nica&#44; secuelas posquir&#250;rgicas y el grado de satisfacci&#243;n de los pacientes con el procedimiento mediante una escala de Likert&#46; El estudio fue aprobado por la Comisi&#243;n de Investigaci&#243;n del HGUCR&#44; se realiz&#243; siguiendo las normas de publicaci&#243;n de datos de pacientes&#44; y obteniendo el consentimiento de los mismos&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">T&#233;cnica quir&#250;rgica de la cirug&#237;a funcional del aparato ungueal &#40;CFAU&#41; &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">figs&#46; 1-3</a>&#41;</span><p id="par0015" class="elsevierStylePara elsevierViewall">Confirmado el diagn&#243;stico por biopsia previa&#44; se procedi&#243; a la ex&#233;resis en bloque del aparato ungueal seg&#250;n la t&#233;cnica<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">3&#44;7</span></a> que describimos a continuaci&#243;n&#46; El procedimiento se realiza mediante anestesia troncular digital&#44; y control de la hemostasia con torniquete&#46; Se marca un margen circunferencial de 5<span class="elsevierStyleHsp" style=""></span>mm alrededor de la l&#225;mina ungueal y de la lesi&#243;n cl&#237;nica cuando esta sobrepasa la l&#225;mina&#44; asegurando la extirpaci&#243;n completa del tumor&#46; La delimitaci&#243;n cl&#237;nica puede precisar ayuda del dermatoscopio&#46; Con bistur&#237; del 15 se incide en profundidad verticalmente hasta el periostio disecando la regi&#243;n subungueal&#44; incluyendo en su totalidad l&#225;mina ungueal&#44; pliegues laterales y proximal&#44; matriz germinal y lecho ungueal&#46; La disecci&#243;n se realiza en profundidad al nivel del periostio subyacente pero respet&#225;ndolo&#44; as&#237; como evitando el da&#241;o de la inserci&#243;n del tend&#243;n extensor&#46; La pieza extirpada en bloque se orienta y marca con seda para su estudio histopatol&#243;gico detallado&#46; Retirado el torniquete&#44; la herida se irriga con soluci&#243;n salina normal y se realiza una hemostasia conservadora&#46; Queda un defecto cuadrangular que puede reducirse seccionando los septos verticales&#44; lo que permite un avance del tejido blando circunferencial y dorsalmente &#40;plastia paroniquial de avance&#41;&#44; que puede aproximarse con suturas en los 4 v&#233;rtices &#40;<a class="elsevierStyleCrossRefs" href="#fig0010">figs&#46; 2 y 3</a>&#41; reduciendo a&#250;n m&#225;s el defecto&#46; Posteriormente se genera una plantilla con el resto del defecto y se cierra con un injerto de piel total&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Revisi&#243;n de la literatura</span><p id="par0020" class="elsevierStylePara elsevierViewall">Se realiz&#243; una b&#250;squeda bibliogr&#225;fica en Medline sobre manejo quir&#250;rgico de los TMSU con cirug&#237;a conservadora &#40;funcional&#47;local amplia&#41;&#44; incluyendo los siguientes t&#233;rminos de b&#250;squeda&#58; tumores malignos subungueales&#44; melanoma subungueal&#44; carcinoma epidermoide subungueal&#44; y cirug&#237;a funcional y&#47;o local amplia en tumores subungueales&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Los criterios de inclusi&#243;n para la revisi&#243;n bibliogr&#225;fica fueron&#58; estudios originales con evaluaciones completas de series de 4 o m&#225;s casos de MSU y&#47;o CESU manejados mediante t&#233;cnica quir&#250;rgica que incluya CFAU y sus variantes&#44; especificando espesor de los tumores &#40;Breslow&#41;&#44; resultados finales &#40;recurrencias y mortalidad&#41; y con un seguimiento m&#237;nimo de 2 a&#241;os&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Resultados</span><p id="par0030" class="elsevierStylePara elsevierViewall">Se extirparon un total de 11 TMSU &#40;7 MSU y 4 CESU&#41;&#44; en 5 mujeres y 6 varones de raza cauc&#225;sica&#44; con edades comprendidas entre los 45 y 81 a&#241;os &#40;edad media&#58; 61 a&#241;os&#41;&#46; Las caracter&#237;sticas cl&#237;nicas de los pacientes &#40;<a class="elsevierStyleCrossRefs" href="#fig0020">figs&#46; 4 y 5</a>&#41; y los tipos de tumores extirpados se describen en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; El diagn&#243;stico se llev&#243; a cabo&#44; de media&#44; en los 35&#44;1 meses despu&#233;s del inicio de los s&#237;ntomas &#40;rango&#58; 6-120 meses&#41;&#46; Este retraso diagn&#243;stico fue similar&#44; de media&#44; entre los MSU &#40;37&#44;1 meses&#41; y los CESU &#40;31&#44;5 meses&#41;&#46; Previamente al tratamiento quir&#250;rgico se realiz&#243; biopsia confirmatoria en todos los pacientes&#59; en los 4 CESU se realiz&#243; tambi&#233;n radiolog&#237;a &#243;sea la cual result&#243; normal en todos ellos&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">En 2 pacientes con melanoma invasivo se efectu&#243; amputaci&#243;n&#44; y en los 9 restantes se opt&#243; por CFAU con extirpaci&#243;n del aparato ungueal&#44; con m&#225;rgenes lesionales de 5<span class="elsevierStyleHsp" style=""></span>mm y resecci&#243;n profunda supraperi&#243;stica &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">figs&#46; 1-3</a>&#41;&#44; as&#237; como posterior reconstrucci&#243;n del defecto quir&#250;rgico mediante un injerto de piel total&#44; seg&#250;n la t&#233;cnica descrita previamente&#46; Tras el estudio histopatol&#243;gico&#44; solamente un caso evidenci&#243; afectaci&#243;n del borde&#44; requiriendo ampliaci&#243;n&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">El estudio cl&#237;nico y radiol&#243;gico inicial realizado tras la cirug&#237;a mostr&#243; enfermedad localizada en todos los pacientes&#46; En los CESU se solicit&#243; PCR para VPH&#44; que solo detect&#243; su presencia en un caso&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">El tiempo medio de seguimiento fue 39 meses&#44; con un rango de 12-96 meses&#46; No se evidenciaron recidivas locales ni regionales&#46; Hubo un caso con met&#225;stasis a distancia&#44; que correspondi&#243; a una de las 2 amputaciones &#40;caso 3&#41;&#44; con met&#225;stasis cerebrales y muerte a los 31 meses del diagn&#243;stico inicial&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Entre las complicaciones quir&#250;rgicas destacaron&#58; infecci&#243;n de herida &#40;3&#47;11&#41;&#44; esp&#237;culas subungueales &#40;1&#47;11&#41;&#44; rigidez moderada articular de la articulaci&#243;n interfal&#225;ngica distal de un dedo de la mano &#40;1&#47;11&#41; que requiri&#243; fisioterapia&#44; hipersensibilidad al fr&#237;o &#40;3&#47;11&#41;&#44; hipersensibilidad a traumatismos leves &#40;4&#47;11&#41;&#44; disminuci&#243;n leve de la sensibilidad al tacto fino &#40;coger objetos peque&#241;os&#44; &#171;hacer la pinza&#187;&#41; en 3 de los 4 pacientes intervenidos de lesiones en el aparato ungueal de la mano&#44; e hiperqueratosis reactiva en un paciente operado del primer dedo del pie&#46; Los problemas detectados fueron leves y transitorios&#44; con mejor&#237;a o pr&#225;ctica desaparici&#243;n al a&#241;o de la cirug&#237;a&#46; En todos los pacientes la satisfacci&#243;n fue buena&#44; y la afectaci&#243;n en la calidad de vida fue m&#237;nima&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Respecto a la revisi&#243;n bibliogr&#225;fica efectuada en diciembre de 2017 en PubMed&#44; el flujograma puede observarse en la <a class="elsevierStyleCrossRef" href="#fig0030">figura 6</a>&#44; y el resumen de la evidencia publicada para CFAU en MSU y CESU&#44; en las <a class="elsevierStyleCrossRefs" href="#tbl0010">tablas 2 y 3</a>&#46;</p><elsevierMultimedia ident="fig0030"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discusi&#243;n</span><p id="par0060" class="elsevierStylePara elsevierViewall">Nuestros resultados &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41; y la revisi&#243;n realizada &#40;<a class="elsevierStyleCrossRefs" href="#tbl0010">tablas 2 y 3</a>&#41; indican que la CFAU o cirug&#237;a local amplia es una buena alternativa a la amputaci&#243;n en TMSU&#44; con escasas recurrencias locales &#40;&#60;<span class="elsevierStyleHsp" style=""></span>7&#37;&#41; y mejores resultados funcionales y cosm&#233;ticos&#46; Hay una elevada satisfacci&#243;n del paciente&#44; con buen control local de la enfermedad y sin diferencias en supervivencia&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">La unidad ungueal es una estructura compleja y puede verse afectada por una gran diversidad de tumores benignos y malignos<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">1</span></a>&#46; Los TMSU son poco frecuentes y est&#225;n representados fundamentalmente por el CESU y el MSU&#44; ambos con cl&#237;nica variable que exige un alto grado de sospecha para evitar el retraso del diagn&#243;stico el cual dificulta el tratamiento y empeora el pron&#243;stico<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">6&#44;7</span></a>&#46; La rareza de la presentaci&#243;n condiciona la escasa evidencia disponible y obliga a la realizaci&#243;n de revisiones exhaustivas&#44; como la presente&#44; en busca de la mejor evidencia<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">21</span></a>&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">El CESU es el m&#225;s frecuente de los TMSU&#44; afectando varones de edad media&#44; m&#225;s com&#250;nmente en las manos que en los pies<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">6&#44;9&#44;22</span></a>&#46; Simula patolog&#237;a benigna&#44; como onicomicosis&#44; distrofia ungueal traum&#225;tica o inflamatoria&#44; exostosis&#44; verrugas vulgares&#44; granuloma pi&#243;geno&#44; paroniquia cr&#243;nica&#44; entre otros&#44; retrasando el diagn&#243;stico<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">6&#44;23</span></a>&#46; Las met&#225;stasis y la mortalidad son excepcionales<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">6</span></a><span class="elsevierStyleItalic">&#46;</span></p><p id="par0075" class="elsevierStylePara elsevierViewall">El segundo TMSU en frecuencia es el MSU&#44; poco frecuente en la raza cauc&#225;sica &#40;2-3&#37; de los melanomas&#41;<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">24&#44;25</span></a> pero com&#250;n en fototipos altos &#40;20&#37; de los melanomas en raza negra o en asi&#225;ticos&#41;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">5&#44;11</span></a>&#46; Afecta por igual varones y mujeres a partir de la quinta d&#233;cada de la vida&#44; con mayor compromiso de los primeros dedos de las manos y pies&#46; En estadios tempranos aparecen bandas irregulares de melanoniquia&#59; m&#225;s tarde&#44; signo de Hutchinson&#44; y en estadios avanzados&#44; cambios distr&#243;ficos ungueales&#46; Puede ser amelan&#243;tico&#44; retrasando el diagn&#243;stico<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">25&#44;26</span></a>&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">La localizaci&#243;n subungueal es de riesgo en melanoma maligno &#40;MM&#41;&#59; no es claro si por retraso diagn&#243;stico<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">11&#44;25</span></a> o por la propia biolog&#237;a con comportamiento m&#225;s agresivo<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">24</span></a>&#46; La queratina ungueal aumenta la reflexi&#243;n de la luz en lesiones melanoc&#237;ticas con un efecto Tyndall<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">21</span></a> que hace m&#225;s dif&#237;cil categorizar las lesiones&#46; Adem&#225;s&#44; la media de evoluci&#243;n al diagn&#243;stico es muy prolongada en estos pacientes&#46; En nuestra serie fue de 35 meses con Breslow medio de 1&#44;16<span class="elsevierStyleHsp" style=""></span>mm&#44; siendo 4&#47;7 &#40;57&#37;&#41; in situ&#44; pero 2&#47;7 &#40;28&#37;&#41; con Breslow &#62;<span class="elsevierStyleHsp" style=""></span>3&#44;8<span class="elsevierStyleHsp" style=""></span>mm&#46; En otras series los datos son similares&#44; con un 18-25&#37; de MSU in situ<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">11&#44;24</span></a> pero con elevado porcentaje de melanomas gruesos &#40;29-50&#37; &#62;<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>mm&#41;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">11&#44;24&#44;25</span></a>&#46; Por otro lado&#44; los factores relacionados con la elevada mortalidad del MSU son similares a los MM no acros&#58; Breslow&#44; ulceraci&#243;n&#44; positividad de la biopsia selectiva del ganglio centinela y estadio al diagn&#243;stico<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">11&#44;24</span></a>&#46; La dificultad en el diagn&#243;stico y el lento crecimiento son habituales tanto en melanoma lentiginoso acro como en la enfermedad de Bowen o en el CESU bien diferenciado&#46; Mientras la mortalidad del MSU puede ser muy elevada en algunas series &#40;30-40&#37; a 5 a&#241;os&#41;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">2&#44;22&#44;26</span></a>&#44; el CESU se comporta&#44; por el contrario&#44; de manera especialmente benigna&#46; En las dos series m&#225;s extensas publicadas<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">6&#44;8</span></a> &#40;104 pacientes entre las dos&#41; no hubo met&#225;stasis ni mortalidad&#46; Solo 10 casos de CESU con met&#225;stasis y 3 con mortalidad hab&#237;an sido reportados hasta 2013<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">8</span></a>&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">No existen recomendaciones s&#243;lidas de manejo quir&#250;rgico de los TMSU<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">6&#44;13</span></a>&#46; El MSU ni se menciona en las gu&#237;as europea &#40;ESMO&#41;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">27</span></a> o escocesa &#40;SIGN&#41;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">28</span></a>&#44; o solo tratan sobre recomendaciones de biopsia previa en la americana &#40;AAD 2011&#41;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">29</span></a> o en la NCCN<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">30</span></a>&#46; La &#250;nica gu&#237;a con recomendaciones de manejo sobre MSU es la australiana &#40;2008&#41;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">31</span></a>&#44; actualmente en revisi&#243;n&#46; Esta gu&#237;a recomienda margen de extirpaci&#243;n seg&#250;n Breslow si es practicable&#44; incluyendo amputaci&#243;n digital parcial por la articulaci&#243;n m&#225;s proximal al melanoma&#46; La gu&#237;a menciona en 2008 la posibilidad de realizar amputaci&#243;n &#171;funcional&#187; pues no se demuestra ventaja de las amputaciones m&#225;s agresivas&#44; siendo la evidencia escasa dada la baja incidencia de esta neoplasia&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Esta falta de recomendaciones contrasta con que en la &#250;ltima d&#233;cada se hayan reportado series de pacientes con cirug&#237;as m&#225;s conservadores que la cl&#225;sica amputaci&#243;n &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46; Debido&#44; en parte&#44; a la falta de grandes series y escasos estudios multic&#233;ntricos&#44; a&#250;n existe controversia en relaci&#243;n con la eficacia de las diferentes modalidades de tratamiento quir&#250;rgico<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">13&#44;25</span></a>&#44; y si estos influyen en la supervivencia global del paciente<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">5&#44;6&#44;17</span></a>&#46; La cirug&#237;a de amputaci&#243;n cl&#225;sica m&#225;s o menos agresiva<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">2&#44;26</span></a> conlleva problemas funcionales&#44; pobres resultados est&#233;ticos&#44; e incluso repercusiones psicol&#243;gicas<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">32</span></a>&#46; En la mano&#44; la amputaci&#243;n del dedo a nivel de la articulaci&#243;n interfal&#225;ngica del pulgar se asocia a p&#233;rdida del 10&#37; de la funci&#243;n&#44; y del 40&#37; si es a nivel de la articulaci&#243;n metacarpofal&#225;ngica<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">5&#44;7&#44;32</span></a>&#44; por acortamiento y desinserci&#243;n del tend&#243;n flexor distal dificultando la pinza<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">32</span></a>&#46; Adem&#225;s&#44; en el &#225;rea de amputaci&#243;n puede haber alteraciones en la sensibilidad que dificultan las actividades cotidianas&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Desde los a&#241;os 90 conocemos que el nivel de amputaci&#243;n no evidencia beneficios en recurrencia ni en supervivencia para las amputaciones proximales m&#225;s agresivas en MSU<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">2&#44;33-35</span></a>&#46; Ello llev&#243; a plantear la CFAU o cirug&#237;a local amplia &#40;WLE&#44; en ingl&#233;s&#41; que extirpa en bloque el aparato ungueal&#44; sin amputaci&#243;n &#243;sea&#46; En 2003 Moherle et al&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">3</span></a> publicaron 62 MSU tratados 31 con amputaci&#243;n y 31 con CFAU&#44; sin diferencias en supervivencia libre de enfermedad ni global entre ambos grupos&#46; Solo hubo 2 recurrencias locales en el grupo de CFAU&#44; destacando que se hizo control 3D&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Las series analizadas &#40;<a class="elsevierStyleCrossRefs" href="#tbl0010">tablas 2 y 3</a>&#41; muestran 243 MSU y 103 CESU manejados mediante CFAU&#46; La mayor&#237;a son TMSU in situ&#44; delgados o poco invasivos&#44; con excelentes resultados funcionales y est&#233;ticos&#44; sin que se modifique el pron&#243;stico&#46; Las recurrencias son escasas y locales generalmente&#46; Para CESU hubo un 8&#44;7&#37; de recurrencia local&#44; no hubo met&#225;stasis ni mortalidad en los 103 pacientes publicados&#46; Para MSU la recurrencia local fue del 4&#44;9&#37; en 12 de los 243 casos tratados con CFAU&#44; y con apenas un 4&#37; de otro tipo de recurrencias &#40;2 satelitosis y 8 nodales&#41;&#46; Se explica pues que la mayor&#237;a fueron tumores in situ&#44; o con Breslow &#60;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>mm&#46; Apenas 30 tumores tratados con CFAU fueron de m&#225;s de 1<span class="elsevierStyleHsp" style=""></span>mm de Breslow&#46; El procedimiento en todos los estudios requiri&#243; extirpaci&#243;n del aparato ungueal en bloque para su adecuado estudio histopatol&#243;gico&#44; y con m&#225;rgenes recomendados de entre 5 y 10<span class="elsevierStyleHsp" style=""></span>mm&#46; La resecci&#243;n puede incluir<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">11</span></a> o no<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">3</span></a> el periostio&#44; sin que suponga diferencias en resultados quir&#250;rgicos ni en la evoluci&#243;n&#46; Un deslizamiento circular y dorsal de los m&#225;rgenes laterales y distal &#40;plastia paroniquial de avance&#41; disminuye el defecto&#44; y facilita cubrirlo con un injerto&#46; En las primeras descripciones se dejaban curar por segunda intenci&#243;n<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">10</span></a>&#44; y en las m&#225;s modernas existe la opci&#243;n de cubrir con sustitutos d&#233;rmicos &#40;INTEGRA&#8482;&#41;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">5</span></a>&#46; Ambas opciones son m&#225;s recomendables cuando se extirpa periostio o hay dudas en la cirug&#237;a sobre la afectaci&#243;n de los m&#225;rgenes&#46; De inicio la t&#233;cnica se acompa&#241;aba de cirug&#237;a de Mohs<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">10</span></a> o 3D<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">3</span></a>&#44; pero hoy d&#237;a est&#225; en duda su utilidad en lesiones ungueales&#44; especialmente si no se extirpa la u&#241;a en su totalidad&#44; pues la complejidad anat&#243;mica por los repliegues dificulta la interpretaci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">6&#44;9</span></a>&#46; En cualquier caso el estudio histol&#243;gico posquir&#250;rgico debe ser meticuloso&#44; asegurando la extirpaci&#243;n completa del tumor&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Es muy interesante la discusi&#243;n acerca de la escasa distancia entre la matriz ungueal y el reborde &#243;seo&#44; que es de solo 0&#44;9<span class="elsevierStyleHsp" style=""></span>mm en un estudio en cad&#225;veres<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">36</span></a>&#46; Este hecho se argumenta como principal limitante para CFAU frente a amputaci&#243;n en el caso de tumores invasivos&#59; no as&#237; en los no invasivos&#44; en los que la distancia ser&#237;a suficiente<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">5</span></a>&#46; Sin embargo&#44; en un estudio anat&#243;mico sobre 30 piezas de amputaci&#243;n de MSU invasivo<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">37</span></a> no hubo afectaci&#243;n &#243;sea en ninguno de los 14 MSU con Breslow &#60;<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>mm y solo en 4 de 16 con Breslow &#62;<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>mm&#46; Los autores concluyen que la CFAU es factible de realizar con seguridad en tumores de grosores intermedios de hasta 4<span class="elsevierStyleHsp" style=""></span>mm&#46; El an&#225;lisis de la revisi&#243;n practicada &#40;<a class="elsevierStyleCrossRefs" href="#tbl0010">tablas 2 y 3</a>&#41; indica que frente a realizar amputaci&#243;n hoy d&#237;a parece clara la indicaci&#243;n de la CFAU en TMSU no invasivos &#40;in situ&#41;&#44; o m&#237;nimamente invasivos &#40;&#60;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>mm&#41;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">6&#44;16</span></a>&#46; Hay m&#225;s dudas sobre el uso en lesiones m&#225;s gruesas<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">5&#44;22</span></a>&#44; pero se ha usado tanto en MSU como en CESU&#44; sin otros signos de mal pron&#243;stico&#44; o en situaciones donde el paciente rechace la amputaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">38</span></a>&#46; Las tasas de recurrencia local son bajas &#40;8&#44;7&#37; en CESU y 4&#44;9&#37; en MSU&#41;&#46; No hubo met&#225;stasis regionales ni mortalidad en ninguno de los 103 CESU tratados con CFAU&#46; Respecto a los MSU&#44; ninguno de los tratados con CFAU con Breslow &#60;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>mm tuvieron met&#225;stasis regionales ni mortalidad&#44; que s&#237; apareci&#243; en los melanomas m&#225;s gruesos&#46; Como otros autores<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">3&#44;5</span></a>&#44; pensamos que esa capacidad de diseminaci&#243;n depende de los factores habituales &#40;Breslow&#44; ulceraci&#243;n&#44; positividad de ganglio centinela&#41; y no de la agresividad de la cirug&#237;a local&#46; Esta debe ser suficiente para asegurar la resecci&#243;n completa del tumor&#44; siendo id&#243;nea en un importante grupo de pacientes la extirpaci&#243;n en bloque del aparato ungueal &#40;CFAU&#41; sin amputaci&#243;n&#46; Extirpaciones limitadas y tumorectom&#237;as tienen m&#225;s riesgo de recidiva y posterior diseminaci&#243;n si es detectada tard&#237;amente&#46; Las tumorectom&#237;as de TMSU tienen m&#225;rgenes dif&#237;ciles de estudiar histol&#243;gicamente&#44; y quedan restos ungueales con peores resultados cosm&#233;ticos que la ex&#233;resis en bloque &#40;CFAU&#41;&#46; En tumores de mayor espesor &#40;Breslow &#62;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; la CFAU &#8212;aunque m&#225;s discutida&#8212; es factible&#44; con menor riesgo en CESU<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">1</span></a> que en MSU<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">8&#44;23</span></a>&#46; La amputaci&#243;n&#44; lo m&#225;s distal posible&#44; se reservar&#237;a para tumores invasivos con afectaci&#243;n &#243;sea o articular&#44; lesiones recurrentes&#44; y Breslow &#62;<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>mm<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">3&#44;5&#44;6</span></a>&#46; En MSU de grosores intermedios &#40;1-4<span class="elsevierStyleHsp" style=""></span>mm&#41;&#44; conviene discutir riesgo-beneficio con el paciente&#44; y en caso de optar por CFAU&#44; realizar un cuidadoso estudio histol&#243;gico de m&#225;rgenes<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">3&#44;5&#44;11</span></a>&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Entre las complicaciones de la CFAU se han reportado&#58; infecci&#243;n de herida quir&#250;rgica&#44; quistes de inclusi&#243;n&#44; esp&#237;culas ungueales&#44; rigidez articular&#44; hiperqueratosis reactiva&#44; dolor y&#47;o hipersensibilidad digital a traumatismos leves&#44; hipersensibilidad al fr&#237;o&#44; disminuci&#243;n de la sensibilidad al tacto fino<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">1&#44;2&#44;20</span></a>&#46; Estos efectos secundarios son bien tolerados&#44; con leve o ausente afectaci&#243;n a la calidad de vida<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">1&#44;20</span></a>&#44; como tambi&#233;n evidencia nuestra serie&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Entre las limitaciones de nuestro estudio se encuentran el car&#225;cter retrospectivo&#44; el escaso n&#250;mero de casos&#44; y la combinaci&#243;n de dos estirpes histol&#243;gicas de comportamiento biol&#243;gico diferente&#44; pero con un manejo quir&#250;rgico similar por su localizaci&#243;n&#46; Como fortalezas destacan el minucioso estudio de cada paciente y la detallada revisi&#243;n bibliogr&#225;fica realizada&#46; La baja frecuencia de estos tumores har&#237;a de gran inter&#233;s la realizaci&#243;n de estudios multic&#233;ntricos y&#47;o registros con un n&#250;mero suficiente de casos&#44; permitiendo mejorar y protocolizar las indicaciones&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conclusiones</span><p id="par0120" class="elsevierStylePara elsevierViewall">Podemos concluir que la evidencia disponible para TMSU posiciona a la CFAU como modalidad terap&#233;utica de elecci&#243;n para el manejo de CESU sin afectaci&#243;n &#243;sea y de MSU no invasivo o delgado &#40;Breslow &#60;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>mm&#41;&#46; Nuestra serie y los casos publicados tienen escasas recurrencias&#44; y mejores resultados funcionales y est&#233;ticos frente a la amputaci&#243;n&#46; Se puede valorar con el paciente su uso en MSU de grosores intermedios &#40;1-4<span class="elsevierStyleHsp" style=""></span>mm&#41;&#44; siempre con un detallado estudio histol&#243;gico de m&#225;rgenes de la pieza de extirpaci&#243;n que asegure la resecci&#243;n completa&#46; Por el contrario&#44; en CESU con afectaci&#243;n &#243;sea&#44; MSU muy grueso &#40;&#62;<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>mm&#41; o recurrencias&#44; la amputaci&#243;n es de elecci&#243;n&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflicto de intereses</span><p id="par0125" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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              "titulo" => "T&#233;cnica quir&#250;rgica de la cirug&#237;a funcional del aparato ungueal &#40;CFAU&#41; &#40;figs&#46; 1-3&#41;"
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              "titulo" => "Revisi&#243;n de la literatura"
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            1 => "Carcinoma epidermoide subungueal"
            2 => "Cirug&#237;a funcional"
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    "resumen" => array:2 [
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Antecedentes y objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El tratamiento cl&#225;sico de los tumores malignos subungueales &#40;TMSU&#41;&#44; carcinoma epidermoide &#40;CESU&#41; y melanoma &#40;MSU&#41;&#44; es la amputaci&#243;n&#46; La cirug&#237;a funcional del aparato ungueal &#40;CFAU&#41; puede preservar la funci&#243;n sin modificar el pron&#243;stico&#46; Presentamos nuestra serie de TMSU manejados con CFAU&#44; describimos la t&#233;cnica y revisamos sus indicaciones&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Material y m&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional retrospectivo de TMSU tratados con CFAU entre 2008 y 2017&#44; con ex&#233;resis supraperi&#243;stica en bloque del aparato ungueal&#44; margen a 5<span class="elsevierStyleHsp" style=""></span>mm&#44; y cierre con injerto de piel total&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Se trataron 11 TMSU&#44; de los cuales 7 fueron MSU &#40;4 in situ&#44; espesor medio&#58; 1&#44;17<span class="elsevierStyleHsp" style=""></span>mm&#59; rango&#58; 0-4<span class="elsevierStyleHsp" style=""></span>mm&#41; y 4 CESU &#40;espesor medio&#58; 3&#44;4<span class="elsevierStyleHsp" style=""></span>mm&#59; rango&#58; 1&#44;6-6<span class="elsevierStyleHsp" style=""></span>mm&#41;&#46; Se realiz&#243; CFAU en 9 casos y 2 amputaciones en sendos MSU invasivos&#46; El seguimiento medio fue 39 meses&#44; con un rango de 12-96 meses&#46; No hubo recidivas locales ni regionales&#46; Solo un caso &#8212;una de las 2 amputaciones&#8212; tuvo met&#225;stasis &#40;cerebrales&#41; y muerte&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La revisi&#243;n de la literatura de CFAU en TMSU mostr&#243; 5 series &#40;103 pacientes en total&#41; con CESU y 14 series &#40;243 pacientes en total&#41; con MSU&#46; El an&#225;lisis de nuestros casos y de los casos publicados muestra muy escasas recurrencias locales &#40;&#60;<span class="elsevierStyleHsp" style=""></span>7&#37;&#41;&#44; y mejores resultados funcionales y est&#233;ticos frente a la amputaci&#243;n&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusiones</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La CFAU es de elecci&#243;n en CESU sin afectaci&#243;n &#243;sea y MSU no invasivo o delgado &#40;Breslow &#60;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>mm&#41;&#46; Es factible en MSU de grosores intermedios siempre con detallado estudio histol&#243;gico de m&#225;rgenes que asegure una resecci&#243;n completa&#46; Por el contrario&#44; en CESU con afectaci&#243;n &#243;sea&#44; MSU muy grueso &#40;&#62;4<span class="elsevierStyleHsp" style=""></span>mm&#41; o recurrencias&#44; la amputaci&#243;n debe ser habitualmente de elecci&#243;n&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
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            "titulo" => "Antecedentes y objetivos"
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          1 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Material y m&#233;todos"
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Background and objectives</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Amputation is the conventional treatment for malignant subungual tumors &#40;MSUTs&#41;&#44; namely&#44; subungual squamous cell carcinoma &#40;SUSCC&#41; and subungual melanoma &#40;SUM&#41;&#46; Functional surgery consisting of wide local excision &#40;WLE&#41; of the nail unit can preserve function without modifying prognosis in such cases&#46; We present a series of MSUTs treated with WLE of the nail unit&#44; describe the technique&#44; and review its indications&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Material and methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Retrospective observational study of MSUTs treated with WLE of the nail unit between 2008 and 2017&#46; The technique consisted of en bloc supraperiosteal excision of the nail unit with a margin of 5<span class="elsevierStyleHsp" style=""></span>mm followed by repair with a full-thickness graft&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Eleven MSUTs were treated in the study period&#58; 7 SUMs &#40;4 in situ&#59; mean thickness&#44; 1&#46;17<span class="elsevierStyleHsp" style=""></span>mm&#59; range&#44; 0-4<span class="elsevierStyleHsp" style=""></span>mm&#41; and 4 SUSCCs &#40;mean thickness&#44; 3&#46;4<span class="elsevierStyleHsp" style=""></span>mm&#59; range&#44; 1&#46;6-6<span class="elsevierStyleHsp" style=""></span>mm&#41;&#46; WLE of the nail unit was performed in 9 patients and amputation in 2 patients with invasive SUM&#46; Mean follow-up was 39 months &#40;range&#44; 12-96 months&#41; and no local or regional recurrences were detected&#46; One of the 2 patients who underwent amputation developed metastasis to the brain and died&#46; In our review of the literature&#44; we identified 5 series of patients with SUSCC treated with WLE of the nail unit &#40;105 patients&#41; and 14 series of patients with SUM &#40;243 patients&#41;&#46; Based on an analysis of these cases and ours&#44; it would appear that WLE of the nail unit is associated with a very low rate of local recurrence &#40;&#60;<span class="elsevierStyleHsp" style=""></span>7&#37;&#41; and offers better functional and cosmetic outcomes than amputation&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">WLE of the nail unit is the treatment of choice for SUSCC without bone involvement and for thin noninvasive SUM &#40;Breslow depth &#60;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>mm&#41;&#46; It is also feasible in intermediate-thickness SUMs when detailed histologic examination of the margins confirms complete resection&#46; Amputation&#44; by contrast&#44; is the treatment of choice for SUSCCs with bone involvement&#44; very thick SUMs &#40;&#62;<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>mm&#41;&#44; and recurrent tumors&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Background and objectives"
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          1 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Material and methods"
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          2 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Results"
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          3 => array:2 [
            "identificador" => "abst0045"
            "titulo" => "Conclusions"
          ]
        ]
      ]
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        "tipo" => "MULTIMEDIAFIGURA"
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          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Caso 1&#58; cirug&#237;a funcional del aparato ungueal &#40;CFAU&#41; de melanoma subungueal &#40;MSU&#41; amelan&#243;tico in situ con onicodistrofia completa del &#237;ndice de la mano izquierda&#46; Resultados a los 2 a&#241;os&#46;</p>"
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        "etiqueta" => "Figura 2"
        "tipo" => "MULTIMEDIAFIGURA"
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          "es" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Caso 10&#58; cirug&#237;a funcional del aparato ungueal &#40;CFAU&#41; de carcinoma epidermoide subungueal &#40;CESU&#41; moderadamente diferenciado&#44; de 4<span class="elsevierStyleHsp" style=""></span>mm de espesor&#44; con onicodistrofia extensa del primer dedo de la mano derecha&#46; Resultado a los 6 meses&#46;</p>"
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        "tipo" => "MULTIMEDIAFIGURA"
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          "es" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Caso 11&#58; cirug&#237;a funcional del aparato ungueal &#40;CFAU&#41; de carcinoma epidermoide subungueal &#40;CESU&#41; moderadamente diferenciado&#44; de 6<span class="elsevierStyleHsp" style=""></span>mm de espesor&#44; con tumoraci&#243;n excrecente sobre onicodistrofia del primer dedo del pie izquierdo&#46; Resultado a los 4 meses&#46;</p>"
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        "identificador" => "fig0020"
        "etiqueta" => "Figura 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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          "es" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Cl&#237;nica de los 7 casos de melanoma subungueal &#40;MSU&#41;&#46;</p>"
        ]
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        "etiqueta" => "Figura 5"
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          "es" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Cl&#237;nica de los 4 casos de carcinoma epidermoide subungueal &#40;CESU&#41;&#46;</p>"
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        "etiqueta" => "Figura 6"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
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          "es" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Flujograma de la revisi&#243;n de la literatura practicada sobre cirug&#237;a funcional del aparato ungueal &#40;CFAU&#41; en tumores malignos subungueales &#40;TMSU&#41;&#46;</p>"
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            "rol" => "short"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">AMP&#58; amputaci&#243;n&#59; CESU&#58; carcinoma epidermoide subungueal&#59; CFAU&#58; cirug&#237;a funcional del aparato ungueal&#59; DU&#58; distrofia ungueal&#59; dx&#58; diagn&#243;stico&#59; F&#58; femenino&#59; HQ hiperqueratosis&#59; M&#58; masculino&#59; MQ&#58; melanoniquia&#59; MSU&#58; melanoma subungueal&#46;</p>"
          "tablatextoimagen" => array:1 [
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Caso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sexo&#47;Edad&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Fecha dx&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Localizaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Presentaci&#243;n cl&#237;nica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Evoluci&#243;n &#40;meses&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Tipo de TMSU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#205;ndice de Breslow&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CFAU&#47;Amputaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Recurrencias&#47;Mortalidad&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Seguimiento &#40;meses&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&#47;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Segundo dedo de mano izquierda&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">DU total amelan&#243;tica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">MSU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">In situ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CFAU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&#47;No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&#47;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Tercer dedo de mano derecha&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">MQ difusa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">MSU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">In situ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CFAU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&#47;No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&#47;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cuarto dedo de pie derecho&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Tumoraci&#243;n pigmentada subungueal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">MSU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4<span class="elsevierStyleHsp" style=""></span>mm ulcerado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">AMP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Met&#225;stasis cerebrales&#47;S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31 &#40;muerte&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&#47;78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Primer dedo de mano izquierda&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">MQ longitudinal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">MSU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">In situ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CFAU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&#47;No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&#47;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Segundo dedo de mano derecha&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">MQ longitudinal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">MSU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">In situ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CFAU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&#47;No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&#47;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2016&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Primer dedo de pie derecho&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">MQ longitudinal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">MSU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;38<span class="elsevierStyleHsp" style=""></span>mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CFAU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&#47;No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&#47;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Primer dedo de pie izquierdo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">DU completa y MQ extensa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">120&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">MSU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#44;8<span class="elsevierStyleHsp" style=""></span>mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">AMP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&#47;No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&#47;61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Primer dedo de pie izquierdo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HQ&#47;DU completa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CESU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2<span class="elsevierStyleHsp" style=""></span>mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CFAU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&#47;No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&#47;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Primer dedo de pie derecho&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HQ&#47;DU lateral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CESU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;5<span class="elsevierStyleHsp" style=""></span>mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CFAU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&#47;No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&#47;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Primer dedo de mano derecha&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HQ&#47;DU central onic&#243;lisis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CESU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4<span class="elsevierStyleHsp" style=""></span>mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CFAU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&#47;No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&#47;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Primer dedo de pie izquierdo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Tumoraci&#243;n excrecente y DU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CESU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6<span class="elsevierStyleHsp" style=""></span>mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CFAU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&#47;No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "es" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas epidemiol&#243;gicas&#44; cl&#237;nicas y evoluci&#243;n de los pacientes con tumores malignos subungueales</p>"
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          "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">CFAU&#58; cirug&#237;a funcional del aparato ungueal&#59; NE&#58; no especificado&#59; NRecL&#58; n&#250;mero de recurrencias locales&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Autor&#44; a&#241;o &#40;Pa&#237;s&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Periodo de estudio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total tumores&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No invasivos &#40;in situ&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Invasivos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Breslow medio &#40;rango&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Amputaci&#243;n &#40;NRecL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Extirpaci&#243;n limitada &#40;NRecL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CFAU completa &#40;NRecL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Met&#225;stasis&#47;Mortalidad&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Seguimiento medio &#40;meses&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Topin-Ruiz et al&#46;&#44; 2017 &#40;Francia&#41;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">6</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2000-2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">55 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#47;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lecerf et al&#46;&#44; 2013 &#40;B&#233;lgica&#41;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">8</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1995-2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;47 &#40;1&#44;5-8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13 &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#47;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40 &#40;4-177&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dalle et al&#46;&#44; 2007 &#40;Francia&#41;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">9</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2000-2005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;1 &#40;0&#44;3 a 2&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#47;1<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31 &#40;10-90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lazar et al&#46;&#44; 2005 &#40;Francia&#41;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">4</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1995-2000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#47;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">De Berker et al&#46;&#44; 1996 &#40;RU&#41;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">10</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1988-1994&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#47;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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              "identificador" => "tblfn0005"
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">En 20 pacientes solo biopsia y otros tratamientos como 5<span class="elsevierStyleHsp" style=""></span>FU&#44; bleomicina&#44; imiquimod o terapia fotodin&#225;mica&#46;</p>"
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          "es" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Series originales de carcinoma epidermoide subungueal que incluyen en el manejo la cirug&#237;a funcional del aparato ungueal</p>"
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          "leyenda" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">AMP&#58; amputaci&#243;n&#59; CFAU&#58; cirug&#237;a funcional del aparato ungueal&#59; IB&#58; &#237;ndice Breslow&#59; L&#58; local&#59; Mort&#46;&#58; mortalidad&#59; N&#58; nodal&#59; NA&#58; no aplicable&#59; NE&#58; no especificado&#59; Recs&#58; recurrencias&#59; S&#58; sist&#233;mica&#59; Seg&#46;&#58; seguimiento&#59; SG&#58; supervivencia global&#59; T&#58; tr&#225;nsito&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Autor&#44; a&#241;o &#40;pa&#237;s&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Periodo estudio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">N&#250;m&#46; casos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">In situ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#60;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#62;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">IB medio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">AMP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CFAU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Recs &#40;IB<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Recs &#40;IB<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mort&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Seg&#46; &#40;meses&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Ogata et al&#46;&#44; 2017 &#40;Jap&#243;n&#41;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">11</span></a></td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">200-13</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">148</td><td class="td" title="table-entry  " align="left" valign="top">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">SG<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a></td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">112</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">112&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lee et al&#46;&#44; 2017 &#40;Korea&#41;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">12</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2011-16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="left" valign="top">17</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1<span class="elsevierStyleHsp" style=""></span>T&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nakamura et al&#46;&#44; 2015 &#40;Jap&#243;n&#41;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">5</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1996-2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1<span class="elsevierStyleHsp" style=""></span>N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sinno et al&#46;&#44; 2015 &#40;EE&#46;<span class="elsevierStyleHsp" style=""></span>UU&#46;&#41;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">13</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2003-2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1<span class="elsevierStyleHsp" style=""></span>L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anda et al&#46;&#44; 2015 &#40;M&#233;xico&#41;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">14</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1989-2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Neczyporenko et al&#46;&#44; 2014 &#40;B&#233;lgica&#41;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">15</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1998-2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Haddock et al&#46;&#44; 2012 &#40;EE&#46;<span class="elsevierStyleHsp" style=""></span>UU&#46;&#41;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">7</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2003-2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sureda et al&#46;&#44; 2011 &#40;Francia&#41;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">16</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2004-2008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Cohen et al&#46;&#44; 2008 &#40;EE&#46;<span class="elsevierStyleHsp" style=""></span>UU&#46;&#41;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">17</span></a></td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">1992-2004</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">49</td><td class="td" title="table-entry  " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3<span class="elsevierStyleHsp" style=""></span>T&#44; 4<span class="elsevierStyleHsp" style=""></span>N&#44; 4<span class="elsevierStyleHsp" style=""></span>S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">SG<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">38</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1<span class="elsevierStyleHsp" style=""></span>L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Rayatt et al&#46;&#44; 2007 &#40;RU&#41;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">18</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1<span class="elsevierStyleHsp" style=""></span>L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lazar et al&#46;&#44; 2005 &#40;Francia&#41;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">4</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1995-2000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">High et al&#46;&#44; 2004 &#40;EE&#46;<span class="elsevierStyleHsp" style=""></span>UU&#46;&#41;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">19</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1997-2002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Glat et al&#46;&#44; 1996 &#40;EE&#46;<span class="elsevierStyleHsp" style=""></span>UU&#46;&#41;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">20</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1982-1995&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#44;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Moehrle et al&#46;&#44; 2003 &#40;Alemania&#41;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">3</span></a></td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">1980-1999</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">62</td><td class="td" title="table-entry  " colspan="2" align="left" valign="top">6</td><td class="td" title="table-entry  " align="left" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="left" valign="top">2<span class="elsevierStyleHsp" style=""></span>L&#44; 1<span class="elsevierStyleHsp" style=""></span>T&#44; 7<span class="elsevierStyleHsp" style=""></span>N&#44; 1<span class="elsevierStyleHsp" style=""></span>S</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">11</td><td class="td" title="table-entry  " align="left" valign="top">55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top">6</td><td class="td" title="table-entry  " align="left" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="left" valign="top">0<span class="elsevierStyleHsp" style=""></span>L&#44; 2<span class="elsevierStyleHsp" style=""></span>T&#44; 7<span class="elsevierStyleHsp" style=""></span>N&#44; 6<span class="elsevierStyleHsp" style=""></span>S</td><td class="td" title="table-entry  " align="left" valign="top">54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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