Videos of Surgical Procedures in Dermatology
Shark Island Flap for Reconstruction of Nasal Ala-Perinasal Defects
Colgajo «en tiburón» para la reconstrucción de defectos de la región alar nasal
M.G. Pérez-Paredes
, L.M. Valladares Narganes, H.A. Cucunubo, M.Á. Rodríguez Prieto
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Servicio de Dermatología, Complejo Asistencial Universitario de León, León, Spain
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Pérez-Paredes, L.M. Valladares Narganes, H.A. Cucunubo, M.Á. Rodríguez Prieto" "autores" => array:4 [ 0 => array:4 [ "nombre" => "M.G." "apellidos" => "Pérez-Paredes" "email" => array:1 [ 0 => "pegemina@yahoo.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "L.M." "apellidos" => "Valladares Narganes" ] 2 => array:2 [ "nombre" => "H.A." "apellidos" => "Cucunubo" ] 3 => array:2 [ "nombre" => "M.Á." "apellidos" => "Rodríguez Prieto" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Complejo Asistencial Universitario de León, León, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Colgajo «en tiburón» para la reconstrucción de defectos de la región alar nasal" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 975 "Ancho" => 1300 "Tamanyo" => 178790 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Result 12 weeks after surgery.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Description</span><p id="par0005" class="elsevierStylePara elsevierViewall">The main objective in dermatologic surgery is complete excision of the tumor whilst achieving the best possible functional and cosmetic outcome. In addition, we must take into account age, sex, and tumor size and site. We should also consider the patient's expectations, the preservation of the different cosmetic units, and the final cosmetic outcome.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The external nose is a facial esthetic unit that is divided into a number of cosmetic subunits that have a similar color, texture, and volume.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The ala nasi and the perialar region are anatomical areas that are commonly affected by neoplastic skin disease. This is a concave region at the confluence of the ala nasi, the lateral wall of the nose, the cheek, and the upper region of the lip. Its reconstruction is a challenge for the dermatologic surgeon, as poor planning of the technique can alter the alar sulcus, nasal symmetry, and the morphology of adjacent cosmetic units, and can produce functional changes such as alar retraction.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The shark flap was first described by Cvancara and Wentzell<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> in 2006. The flap was given this name because it is a myocutaneous island flap shaped like a shark. It is indicated for reconstruction of alar and perialar defects because, when it is performed, it involves a rotation that gives rise to the formation of an inverted cone that recreates the alar sulcus.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The classic flap is a myocutaneous flap that derives its blood supply from the levator labii superioris muscle and requires careful dissection to preserve the vascular pedicle. A variant with a subcutaneous pedicle with randomized vascularization has been described.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> This flap is simpler to perform and there is no increase in the risk of necrosis.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Technique</span><p id="par0030" class="elsevierStylePara elsevierViewall">We present the case of an 84-year-old man with a basal cell carcinoma of 0.8<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>0.8<span class="elsevierStyleHsp" style=""></span>cm on the right ala nasi (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Because of the site and size of the surgical defect created, we decided to use a shark flap for reconstruction.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The distance from the original alar sulcus to the medial border of the defect is measured and the flap is designed so that its superoanterior segment has the same width. The short limb of the flap is derived from the melolabial sulcus and the long limb will make use of the adjacent skin of the cheek. A flap with a subcutaneous pedicle is dissected, and the upper limb is then rotated through 90°, to lie perpendicular to the melolabial part of the flap and thus recreate the alar sulcus. The flap is then elevated and anchored in a superomedial direction. The rest of the flap is sutured, avoiding deep sutures that could increase the risk of necrosis.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In our patient, the postoperative functional and cosmetic outcomes at 12 weeks were good (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The surgical technique is shown in the video.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Indications</span><p id="par0050" class="elsevierStylePara elsevierViewall">The shark flap is indicated for the repair of defects of the alar sulcus and perialar region. It has the advantage that it requires only a single operation, with no need for combination with other techniques (suture anchoring or grafts), and the functional and cosmetic results are good.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,4</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Contraindications</span><p id="par0055" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0060" class="elsevierStylePara elsevierViewall">This technique should not be used for large defects of the alar and perialar region as the cosmetic and functional outcomes will not be as good.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0065" class="elsevierStylePara elsevierViewall">This flap should not be used when cartilage is affected.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p></li></ul></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Complications</span><p id="par0070" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0075" class="elsevierStylePara elsevierViewall">The main complication is flap necrosis, which can be prevented by performing correct dissection, achieving an appropriate length-to-width ratio of the flap, and by placing the sutures superficially to avoid damaging the blood supply (angular artery).</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0080" class="elsevierStylePara elsevierViewall">Deformity of the ala nasi or of adjacent cosmetic structures through a poor design or execution of the flap.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0085" class="elsevierStylePara elsevierViewall">A trap door effect is possible because of the different thicknesses of the skin of the nose and cheek.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,4</span></a></p></li></ul></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="par0090" class="elsevierStylePara elsevierViewall">The shark flap is a simple island flap that can be performed in a single operation. The flap recreates the alar sulcus with good cosmetic and functional results in comparison with other flaps employed in this region.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of Interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Description" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Technique" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Indications" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Contraindications" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Complications" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Conclusions" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of Interest" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-09-22" "fechaAceptado" => "2014-04-04" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Pérez-Paredes MG, Valladares Narganes LM, Cucunubo HA, Rodríguez Prieto MÁ. Colgajo «en tiburón» para la reconstrucción de defectos de la región alar nasal. Actas Dermosifiliogr. 2014;105:709–711.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0105" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0045" ] ] ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1064 "Ancho" => 800 "Tamanyo" => 127437 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Basal cell carcinoma of 0.8<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>0.8<span class="elsevierStyleHsp" style=""></span>cm on the ala nasi, and design of the shark flap.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 975 "Ancho" => 1300 "Tamanyo" => 178790 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Result 12 weeks after surgery.</p>" ] ] 2 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc1.mp4" "ficheroTamanyo" => 78994400 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc1.flv" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:2 [ "fichero" => "mmc1.m4v" "poster" => "mmc1.jpg" ] ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cirugía dermatológica de la pirámide nasal" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M.A. Rodríguez-Prieto" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:4 [ "edicion" => "2.<span class="elsevierStyleSup">a</span> ed" "fecha" => "2012" "editorial" => "Aula Médica" "editorialLocalizacion" => "Madrid" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Shark island pedicle flap for repair of combined nasal ala-perialar defects" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.L. Cvancara" 1 => "J.M. Wentzell" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1524-4725.2006.32146.x" "Revista" => array:6 [ "tituloSerie" => "Dermatol Surg" "fecha" => "2006" "volumen" => "32" "paginaInicial" => "726" "paginaFinal" => "729" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16706770" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Modified shark island flap for combined nasal ala-perialar defects" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R. Carvalho" 1 => "P. Maio" 2 => "P. Lamarao" 3 => "J. Cardoso" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1684/ejd.2011.1320" "Revista" => array:6 [ "tituloSerie" => "Eur J Dermatol" "fecha" => "2011" "volumen" => "21" "paginaInicial" => "612" "paginaFinal" => "613" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21543289" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Shark island pedicle flap for repairing of basal cell carcinoma localized in nasal ala-perialar region: A simple procedure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.C. André" 1 => "A. Fraga" 2 => "C.R. Garcia" 3 => "J.G. Pignatelli" 4 => "R.O. Soares" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "An Bras Dermatol" "fecha" => "2011" "volumen" => "86" "numero" => "4 Supl 1" "paginaInicial" => "160" "paginaFinal" => "163" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21437543" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010500000007/v1_201408281012/S1578219014001929/v1_201408281012/en/main.assets" "Apartado" => array:4 [ "identificador" => "6209" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Videos of Surgical Procedures in Dermatology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010500000007/v1_201408281012/S1578219014001929/v1_201408281012/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219014001929?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 8 | 5 | 13 |
| 2024 Octubre | 179 | 50 | 229 |
| 2024 Septiembre | 225 | 44 | 269 |
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| 2021 Diciembre | 95 | 46 | 141 |
| 2021 Noviembre | 128 | 51 | 179 |
| 2021 Octubre | 97 | 56 | 153 |
| 2021 Septiembre | 76 | 55 | 131 |
| 2021 Agosto | 90 | 35 | 125 |
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| 2019 Noviembre | 0 | 8 | 8 |
| 2019 Octubre | 0 | 8 | 8 |
| 2019 Septiembre | 4 | 7 | 11 |
| 2019 Agosto | 0 | 4 | 4 |
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| 2018 Septiembre | 5 | 3 | 8 |
| 2018 Agosto | 0 | 8 | 8 |
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| 2018 Marzo | 2 | 11 | 13 |
| 2018 Febrero | 34 | 14 | 48 |
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| 2017 Junio | 78 | 30 | 108 |
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| 2017 Marzo | 57 | 20 | 77 |
| 2017 Febrero | 100 | 14 | 114 |
| 2017 Enero | 41 | 16 | 57 |
| 2016 Diciembre | 63 | 15 | 78 |
| 2016 Noviembre | 89 | 22 | 111 |
| 2016 Octubre | 94 | 31 | 125 |
| 2016 Septiembre | 90 | 17 | 107 |
| 2016 Agosto | 0 | 38 | 38 |
| 2016 Julio | 7 | 2 | 9 |
| 2016 Junio | 6 | 4 | 10 |
| 2016 Mayo | 4 | 23 | 27 |
| 2016 Abril | 11 | 17 | 28 |
| 2016 Marzo | 7 | 19 | 26 |
| 2016 Febrero | 8 | 17 | 25 |
| 2016 Enero | 15 | 1 | 16 |
| 2015 Diciembre | 11 | 1 | 12 |
| 2015 Noviembre | 13 | 1 | 14 |
| 2015 Octubre | 17 | 2 | 19 |
| 2015 Septiembre | 9 | 14 | 23 |
| 2015 Agosto | 8 | 5 | 13 |
| 2015 Julio | 91 | 11 | 102 |
| 2015 Junio | 77 | 9 | 86 |
| 2015 Mayo | 79 | 16 | 95 |
| 2015 Abril | 46 | 13 | 59 |
| 2015 Marzo | 43 | 12 | 55 |
| 2015 Febrero | 76 | 11 | 87 |
| 2015 Enero | 64 | 2 | 66 |
| 2014 Diciembre | 116 | 10 | 126 |
| 2014 Noviembre | 135 | 9 | 144 |
| 2014 Octubre | 138 | 10 | 148 |
| 2014 Septiembre | 148 | 8 | 156 |
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