Videos of Surgical Procedures in Dermatology
Rotation Advancement Flap Reconstruction Following Excision of a Squamous Cell Carcinoma in the Infraorbital Malar Region
Reconstrucción de carcinoma espinocelular en región malar infraorbitaria mediante colgajo de rotación-avance
N. Eirís
, G. Pérez Paredes, M.Á. Rodríguez Prieto
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Servicio de Dermatología, Complejo Asistencial Universitario de León, León, Spain
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Eirís, G. Pérez Paredes, M.Á. Rodríguez Prieto" "autores" => array:3 [ 0 => array:4 [ "nombre" => "N." "apellidos" => "Eirís" "email" => array:1 [ 0 => "noemieiris@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "G." "apellidos" => "Pérez Paredes" ] 2 => 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" => "Reconstrucción de carcinoma espinocelular en región malar infraorbitaria mediante colgajo de rotación-avance" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 745 "Ancho" => 996 "Tamanyo" => 173701 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Large squamous cell carcinoma in the malar region.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The cheek region can be divided into 4 areas with different cosmetic properties that must be taken into account during surgical reconstruction: buccal, infraocular or medial, zygomatic or lateral, and mandibular.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2</span></a> Some authors have used the malar prominence, the point of convergence of the borders of these areas, as a reference point. However, the borders between these areas are not clear, depending both on intrinsic factors related to the individual's physionomy and on extrinsic factors associated with photoaging.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In large defects (><span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>cm diameter) affecting the medial area, the most widely used surgical reconstructions use submental or cervicofacial flaps.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,3</span></a> These types of plasty are advanced and rotated during tissue transfer. The flaps, which have a postero-inferior base, have a very rich blood supply derived from the abundant perforating vessels that arise from the transverse and facial arteries.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> Excellent results can also be achieved with island flaps, which take advantage of the abundant subcutaneous adipose tissue of the cheek; or else a combination of the 2 types of flap can be used to achieve adequate skin covering of the defect and avoid tension and secondary ectropion.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> However, the use of grafts is not recommended due to possible retraction and a poorer cosmetic result. The exception is when close monitoring is necessary to detect early recurrence.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The dissection of a cervicofacial flap must be carried out in the subcutaneous plane to preserve the subdermal vascular plexus. The plane deep to the SMAS can be used in thick defects and defects in patients with adverse risk factors for healing (smoking, radiation therapy to the area), though this carries a higher risk of neurovascular injury.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> When the tension vectors of the suture are predominantly vertical, the flap should be fixed to the periostium of the margin of the orbit and to the melonasal sulcus because of the risk of ectropion.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Flap rotation usually gives rise to excess skin that can be eliminated using a Z-plasty or by the excision of Burow triangles, which should be designed in a way to hide scars in the base of a skin fold or crease.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Technique</span><p id="par0020" class="elsevierStylePara elsevierViewall">The patient was a 92-year-old man who was referred to our center for a rapidly growing, poorly defined, ulcerated squamous cell carcinoma of about 3<span class="elsevierStyleHsp" style=""></span>cm diameter affecting the medial malar area and melolabial sulcus (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Given the age of patient and the rapid growth of the lesion, with bleeding and pain, it was decided to perform surgical excision.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">We elected to create a rotation flap (see video). Under general anesthesia, an inferior cheek flap was designed, extending the superior pole of the defect along the natural skinfold of the cheek to the cervical region. The flap was elevated in the subcutaneous plane and was rotated. After confirming good coverage of the defect, the flap was sutured with 4/0 silk. The excess skin was eliminated by 2 small tension-releasing triangles (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Indications</span><p id="par0030" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">•</span><p id="par0035" class="elsevierStylePara elsevierViewall">Large defects (><span class="elsevierStyleHsp" style=""></span>3-4<span class="elsevierStyleHsp" style=""></span>cm diameter) of the malar subunit.</p></li></ul></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Contraindications</span><p id="par0040" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">•</span><p id="par0045" class="elsevierStylePara elsevierViewall">Absolute: none.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">•</span><p id="par0050" class="elsevierStylePara elsevierViewall">Relative: coagulation disorders, extrinsic factors that could predispose to cutaneous ischemia (smoking, previous radiation therapy, etc.), previous surgery to the area that could interfere with flap mobility.</p></li></ul></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Complications</span><p id="par0055" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">•</span><p id="par0060" class="elsevierStylePara elsevierViewall">Surgical wound infection, including skin and deep planes.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">•</span><p id="par0065" class="elsevierStylePara elsevierViewall">Edema, hematoma, and skin necrosis.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">•</span><p id="par0070" class="elsevierStylePara elsevierViewall">Postsurgical ectropion.</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">•</span><p id="par0075" class="elsevierStylePara elsevierViewall">Transient or permanent alterations of sensibility and movement due to injury to nerves, vessels or muscles.</p></li></ul></p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="par0080" class="elsevierStylePara elsevierViewall">The use of a cervicofacial flap for reconstruction of the medial area of the cheek is one of the most useful techniques for the reconstruction of large surgical defects in this area.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> The operation is technically simple, though laborious if extra care is taken to minimize damage to small subjacent blood vessels to reduce postoperative bleeding; when it is necessary to mobilize skin from the cervical region, injury to the neurovascular structures of that region must be avoided.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> The cosmetic and functional results are excellent, as some of the incisions can be hidden in the facial skin folds (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of Interest</span><p id="par0085" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 1 => array:3 [ "identificador" => "sec0010" "titulo" => "Technique" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Indications" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Contraindications" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Complications" ] ] ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Conclusions" ] 3 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of Interest" ] 4 => array:2 [ "identificador" => "xack158208" "titulo" => "Acknowledgments" ] 5 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-08-21" "fechaAceptado" => "2014-12-04" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Eirís N, Pérez Paredes G, Rodríguez Prieto M. Reconstrucción de carcinoma espinocelular en región malar infraorbitaria mediante colgajo de rotación-avance. Actas Dermosifiliogr. 2015;106:319–321.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0100" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0045" ] ] ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 745 "Ancho" => 996 "Tamanyo" => 173701 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Large squamous cell carcinoma in the malar region.</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" => 745 "Ancho" => 996 "Tamanyo" => 153457 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Immediate postoperative appearance; advancement-rotation flap for reconstruction of the surgical defect.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1104 "Ancho" => 995 "Tamanyo" => 237971 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Eight weeks after surgery; the excellent functional and cosmetic result can be seen.</p>" ] ] 3 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc1.mp4" "ficheroTamanyo" => 52015884 "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:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reconstruction of the cheek" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D.T. Bradley" 1 => "C.S. Murakami" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "Local flaps in facial reconstruction" "paginaInicial" => "525" "paginaFinal" => "556" "serieFecha" => "2007" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cirugía reconstructiva de la región cigomática-medial de la mejilla: presentación de 5 casos" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.G. Pérez-Paredes" 1 => "B. González-Sixto" 2 => "M.M. Otero-Rivas" 3 => "M.A. Rodríguez-Prieto" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.adengl.2012.11.029" "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2013" "volumen" => "105" "paginaInicial" => "e27" "paginaFinal" => "e31" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24718266" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reconstruction of cheek defects: A review of current techniques" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "N. Jowett" 1 => "A.M. Mlynarek" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MOO.0b013e32833a6d7f" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Otolaryngol Head Neck Surg" "fecha" => "2010" "volumen" => "18" "paginaInicial" => "244" "paginaFinal" => "254" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20498599" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Local flaps: Cheek and lip reconstruction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.P. Pepper" 1 => "S.R. Baker" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jamafacial.2013.1608" "Revista" => array:6 [ "tituloSerie" => "JAMA Facial Plast Surg" "fecha" => "2013" "volumen" => "15" "paginaInicial" => "374" "paginaFinal" => "382" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24051684" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reconstruction of defects of the infraorbital malar cheek" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E. Rozas-Muñoz" 1 => "R.M. Pujol" 2 => "A. Toll" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1524-4725.2011.02118.x" "Revista" => array:6 [ "tituloSerie" => "Dermatol Surg" "fecha" => "2011" "volumen" => "37" "paginaInicial" => "1675" "paginaFinal" => "1678" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21834932" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack158208" "titulo" => "Acknowledgments" "texto" => "<p id="par0090" class="elsevierStylePara elsevierViewall">To José Lavigne for his help with the production and editing of the video.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010600000004/v2_201505051007/S157821901500058X/v2_201505051007/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/15782190/0000010600000004/v2_201505051007/S157821901500058X/v2_201505051007/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157821901500058X?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 15 | 11 | 26 |
| 2024 Octubre | 82 | 46 | 128 |
| 2024 Septiembre | 140 | 45 | 185 |
| 2024 Agosto | 159 | 75 | 234 |
| 2024 Julio | 113 | 51 | 164 |
| 2024 Junio | 99 | 37 | 136 |
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| 2024 Febrero | 77 | 34 | 111 |
| 2024 Enero | 62 | 41 | 103 |
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| 2023 Noviembre | 109 | 42 | 151 |
| 2023 Octubre | 91 | 23 | 114 |
| 2023 Septiembre | 90 | 42 | 132 |
| 2023 Agosto | 57 | 27 | 84 |
| 2023 Julio | 108 | 62 | 170 |
| 2023 Junio | 63 | 40 | 103 |
| 2023 Mayo | 124 | 34 | 158 |
| 2023 Abril | 57 | 30 | 87 |
| 2023 Marzo | 77 | 29 | 106 |
| 2023 Febrero | 54 | 36 | 90 |
| 2023 Enero | 54 | 34 | 88 |
| 2022 Diciembre | 65 | 37 | 102 |
| 2022 Noviembre | 45 | 29 | 74 |
| 2022 Octubre | 31 | 30 | 61 |
| 2022 Septiembre | 32 | 60 | 92 |
| 2022 Agosto | 41 | 46 | 87 |
| 2022 Julio | 41 | 35 | 76 |
| 2022 Junio | 37 | 36 | 73 |
| 2022 Mayo | 68 | 52 | 120 |
| 2022 Abril | 62 | 48 | 110 |
| 2022 Marzo | 73 | 49 | 122 |
| 2022 Febrero | 62 | 43 | 105 |
| 2022 Enero | 70 | 60 | 130 |
| 2021 Diciembre | 52 | 41 | 93 |
| 2021 Noviembre | 70 | 58 | 128 |
| 2021 Octubre | 76 | 77 | 153 |
| 2021 Septiembre | 44 | 39 | 83 |
| 2021 Agosto | 70 | 36 | 106 |
| 2021 Julio | 57 | 52 | 109 |
| 2021 Junio | 109 | 48 | 157 |
| 2021 Mayo | 46 | 47 | 93 |
| 2021 Abril | 175 | 108 | 283 |
| 2021 Marzo | 108 | 36 | 144 |
| 2021 Febrero | 71 | 37 | 108 |
| 2021 Enero | 62 | 30 | 92 |
| 2020 Diciembre | 53 | 25 | 78 |
| 2020 Noviembre | 34 | 26 | 60 |
| 2020 Octubre | 33 | 13 | 46 |
| 2020 Septiembre | 66 | 14 | 80 |
| 2020 Agosto | 37 | 18 | 55 |
| 2020 Julio | 23 | 18 | 41 |
| 2020 Junio | 40 | 31 | 71 |
| 2020 Mayo | 35 | 27 | 62 |
| 2020 Abril | 34 | 24 | 58 |
| 2020 Marzo | 25 | 20 | 45 |
| 2020 Febrero | 5 | 9 | 14 |
| 2020 Enero | 4 | 11 | 15 |
| 2019 Diciembre | 6 | 7 | 13 |
| 2019 Noviembre | 4 | 3 | 7 |
| 2019 Octubre | 0 | 7 | 7 |
| 2019 Septiembre | 6 | 6 | 12 |
| 2019 Agosto | 4 | 10 | 14 |
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| 2019 Febrero | 3 | 3 | 6 |
| 2019 Enero | 3 | 3 | 6 |
| 2018 Diciembre | 0 | 3 | 3 |
| 2018 Noviembre | 23 | 5 | 28 |
| 2018 Octubre | 3 | 0 | 3 |
| 2018 Septiembre | 4 | 1 | 5 |
| 2018 Agosto | 0 | 8 | 8 |
| 2018 Julio | 0 | 5 | 5 |
| 2018 Junio | 0 | 4 | 4 |
| 2018 Mayo | 0 | 3 | 3 |
| 2018 Abril | 0 | 7 | 7 |
| 2018 Marzo | 0 | 5 | 5 |
| 2018 Febrero | 53 | 6 | 59 |
| 2018 Enero | 30 | 7 | 37 |
| 2017 Diciembre | 62 | 10 | 72 |
| 2017 Noviembre | 25 | 13 | 38 |
| 2017 Octubre | 22 | 9 | 31 |
| 2017 Septiembre | 14 | 8 | 22 |
| 2017 Agosto | 10 | 28 | 38 |
| 2017 Julio | 19 | 19 | 38 |
| 2017 Junio | 24 | 35 | 59 |
| 2017 Mayo | 32 | 21 | 53 |
| 2017 Abril | 14 | 26 | 40 |
| 2017 Marzo | 13 | 12 | 25 |
| 2017 Febrero | 14 | 14 | 28 |
| 2017 Enero | 17 | 17 | 34 |
| 2016 Diciembre | 25 | 16 | 41 |
| 2016 Noviembre | 44 | 17 | 61 |
| 2016 Octubre | 34 | 12 | 46 |
| 2016 Septiembre | 0 | 19 | 19 |
| 2016 Agosto | 0 | 5 | 5 |
| 2016 Julio | 5 | 3 | 8 |
| 2016 Junio | 8 | 4 | 12 |
| 2016 Mayo | 11 | 12 | 23 |
| 2016 Abril | 6 | 13 | 19 |
| 2016 Marzo | 7 | 10 | 17 |
| 2016 Febrero | 11 | 14 | 25 |
| 2016 Enero | 12 | 15 | 27 |
| 2015 Diciembre | 13 | 9 | 22 |
| 2015 Noviembre | 8 | 16 | 24 |
| 2015 Octubre | 1 | 10 | 11 |
| 2015 Septiembre | 0 | 2 | 2 |
| 2015 Agosto | 0 | 1 | 1 |
| 2015 Julio | 5 | 3 | 8 |
| 2015 Junio | 3 | 2 | 5 |
| 2015 Mayo | 5 | 6 | 11 |
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