Estadísticas

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">In dermatology surgery&#44; a malignant lesion or one with suspicion of malignancy should be completely resected&#44; leaving a sufficient safety margin&#44; which will vary according to the particular case&#46; Once the lesion has been resected&#44; we should consider closing the surgical defect by directly closure&#44; flap advancement&#44; or a graft&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Direct closure is the most widely used reconstruction in simple resections and up to 35&#37; of defects arising after Mohs surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a> To do this appropriately&#44; two apical symmetric and opposing Burow triangles are resected to generate an ellipse whose total length is 3&#8211;4 times the original defect to avoid a dog ear defect&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">2</span></a> In addition&#44; the long axis of the ellipse should be aligned in parallel to the relaxed skin tension lines&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Once these details have been taken into account in the design&#44; the borders are brought together by suture&#46; However&#44; this movement is not the same for all points of the ellipse&#46; The central points of the ellipse are displaced further than the ends to meet in the center&#46; As a result&#44; this central skin &#40;epidermis&#8211;dermis&#8211;subcutaneous tissue&#41; will lose some of its thickness because it is subject to greater tension&#46; This will lead to a central depression in the wound which may contribute to a worse cosmetic outcome&#46; This defect is more evident on the convex surfaces of the body&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Description of the technique</span><p id="par0020" class="elsevierStylePara elsevierViewall">To minimize this defect&#44; we propose a double dermal-subcutaneous confluent flap to provide filling and project to the center of the ellipse&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Following the procedure shown in <a class="elsevierStyleCrossRef" href="#sec0040">Appendix</a>&#44; for the purposes of description&#44; we can identify four steps&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#46;</span><p id="par0030" class="elsevierStylePara elsevierViewall">The relaxed skin tension lines are located and the Burow triangles are aligned with these&#46; With a cold scalpel &#40;blade &#35;15&#41;&#44; the epidermis and superficial dermis of both Burow triangles are resected&#46; As this is a region with hair&#44; this step should reach down to the deep dermis to avoid interference with the hair bulbs&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#46;</span><p id="par0035" class="elsevierStylePara elsevierViewall">Two flaps are constructed from the central subcutaneous pedicle in the bed of both Burow triangles&#46; To this end&#44; the periphery is cut down to the muscle fascia or a safe anatomical plane&#44; such that the resulting flap will include the dermis and subcutaneous fatty tissue&#46; Vascularization of these flaps will occur via the perforating arteries of the underlying muscle&#46; It is helpful that the flap includes the dermis to provide structural collagen support and thus improve the central projections of the scar&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3&#46;</span><p id="par0040" class="elsevierStylePara elsevierViewall">Both flaps are rotated in the vertical plane such that the two apices coincide in the center&#44; which we then suture with resorbable thread&#46; The aim of this step is to give the central area of the ellipse extra volume to improve the projection&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4&#46;</span><p id="par0045" class="elsevierStylePara elsevierViewall">Finally&#44; we dissect the sides as we would with any direct closure and bring the two sides together with subcutaneous and transcutaneous sutures according to the site and defect in question&#46;</p></li></ul></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Indications</span><p id="par0050" class="elsevierStylePara elsevierViewall">In mid-sized defects following repair by direct closure&#44; particularly in convex areas&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Contraindications</span><p id="par0055" class="elsevierStylePara elsevierViewall">In anatomical areas where producing such a deep flap might be associated with risk of vascular and&#47;or nervous lesions&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Complications</span><p id="par0060" class="elsevierStylePara elsevierViewall">Those usually associated with basic dermatology surgery &#40;infection&#44; dehiscence&#44; bleeding&#44; etc&#46;&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="par0065" class="elsevierStylePara elsevierViewall">In this video&#44; we describe a new and simple technique to avoid a central depression in repairs by direct closure&#46; This technique does not require any special training and can be performed by any dermatologist who carries out basic surgical procedures&#46; This technique is particularly useful in convex anatomical areas&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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