Case and Research Letters
Use of the Burow Triangle or Wedge-shaped Resection During the Repair of Infraorbital Defects
Uso del triángulo de Burow o escisión en «V» para la reparación de defectos infraorbitarios
L.M. Molinari
, D. Ferrario, G.N. Galimberti
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Centro de Cáncer de piel y Cirugía Micrográfica de Mohs, Servicio de Dermatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Molinari, D. Ferrario, G.N. Galimberti" "autores" => array:3 [ 0 => array:4 [ "nombre" => "L.M." "apellidos" => "Molinari" "email" => array:1 [ 0 => "leisa.molinari@hospitalitaliano.org.ar" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "D." "apellidos" => "Ferrario" ] 2 => array:2 [ "nombre" => "G.N." "apellidos" => "Galimberti" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Centro de Cáncer de piel y Cirugía Micrográfica de Mohs, Servicio de Dermatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Uso del triángulo de Burow o escisión en «V» para la reparación de defectos infraorbitarios" ] ] "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" => 1151 "Ancho" => 1150 "Tamanyo" => 241338 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Case 1. Surgical resection of a malignant tumor leaving a defect in the infraorbital region. Closure using a Burow triangle or wedge-shaped resection.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Facial reconstruction surgery requires detailed knowledge of anatomic and functional structures such as the nose, eyelids, and lips, because of the importance of preserving their function, shape, and cosmetic appearance.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Various surgical techniques are available to repair defects; the quickest and simplest reconstruction is by direct closure. First, an ellipse must be created; this involves lengthening the surgical incision to eliminate the excess skin at each end of the incision. One technique used to remove excess skin is the Burow triangle or wedge-shaped resection.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The lower eyelid is formed by the orbicularis muscle covered by thin and lax skin. The infraorbital region is the area immediately inferior and medial to the lower eyelid, and the malar region is inferior and lateral to this eyelid; lower down these 2 regions give rise to the cheek. These facial cosmetic areas have different textures, colors, and densities, from a fine skin with minimal subcutaneous cellular tissue in the eyelid to the thicker skin of the cheek, strongly adherent to the subcutaneous cellular tissue.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In the repair of defects that affect the infraorbital or malar regions, the skin of the cheek is united with the skin of the eyelid, despite these marked differences, and there is the associated risk of provoking eversion of the palpebral margin, separating it from the surface of the eye and producing ectropion.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">We present a simple option for closure that minimizes this possibility.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Surgical Technique</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">First Step: Design</span><p id="par0030" class="elsevierStylePara elsevierViewall">The elliptical excision must be marked before performing anesthesia because the anesthetic injection will distort the anatomy. A Burow triangle is then designed at the medial end (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Second Step: Incision and Dissection of the Skin</span><p id="par0040" class="elsevierStylePara elsevierViewall">It is important to dissect the tissues in the direction of the cheek to achieve better displacement. Do not dissect towards the eyelid because of the fragility of the skin in that area.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Third Step: Anchorage</span><p id="par0045" class="elsevierStylePara elsevierViewall">The first stitch must be placed at the point of greatest tension, which is between points a and a’ shown in <a class="elsevierStyleCrossRef" href="#fig0005">figure 1</a> B, C, and D. This is performed with a nonabsorbable intradermal suture.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Fourth Step: External Sutures</span><p id="par0055" class="elsevierStylePara elsevierViewall">We prefer to use horizontal U stitches buried in the lower eyelid.</p><p id="par0060" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRefs" href="#fig0010">Figures 2 and 3</a> show patients in whom malignant tumors were excised. Closure of the defect was performed using the technique described.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Important Points</span><p id="par0065" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0070" class="elsevierStylePara elsevierViewall">It is essential to make the first stitch a to a’ in a diagonal orientation (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B) to prevent tension perpendicular to free border of the eyelid, which would provoke ectropion.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0075" class="elsevierStylePara elsevierViewall">Protect the skin of the lower eyelid, as it is thin and delicate.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3.</span><p id="par0080" class="elsevierStylePara elsevierViewall">The intradermal suture can cause ectropion if fibers of the orbicularis muscle are included in the suture.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a></p></li></ul></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclusion</span><p id="par0085" class="elsevierStylePara elsevierViewall">We have proposed this technique for infraorbital defects of up to 1<span class="elsevierStyleHsp" style=""></span>cm diameter. In a previous article we described a rotation-advancement flap for larger defects.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">The use of the Burow triangle in the ellipse is not only to remove excess skin, but also to move the point of greatest tension, transferring it to the medial sector of the eyelid, which will minimize the risk of ectropion (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>, C and D).</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:3 [ "identificador" => "sec0005" "titulo" => "Surgical Technique" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "First Step: Design" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Second Step: Incision and Dissection of the Skin" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Third Step: Anchorage" ] 3 => array:2 [ "identificador" => "sec0025" "titulo" => "Fourth Step: External Sutures" ] ] ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Important Points" ] 2 => array:2 [ "identificador" => "sec0035" "titulo" => "Conclusion" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Molinari LM, Ferrario D, Galimberti GN. Use of the Burow Triangle or Wedge-shaped Resection During the Repair of Infraorbital Defects. Actas Dermosifiliogr. 2015;106:689–691.</p>" ] ] "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" => 1150 "Ancho" => 1150 "Tamanyo" => 112370 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Design of the closure; the Burow triangle is designed at the medial end of the incision. B, Anchorage of the ellipse; a to a’ orientation of the first stitch. C, Diagonal movement of the skin. D, Final closure. The points indicate the area of greatest tension when the borders are united.</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" => 1151 "Ancho" => 1150 "Tamanyo" => 241338 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Case 1. Surgical resection of a malignant tumor leaving a defect in the infraorbital region. Closure using a Burow triangle or wedge-shaped resection.</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" => 1300 "Ancho" => 1300 "Tamanyo" => 326359 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Case 2. Surgical resection of a malignant tumor leaving a defect in the infraorbital region. Closure using a Burow triangle or wedge-shaped resection.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Colgajos de avance con triángulo de Burow en la cara" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Pérez Santos" 1 => "R. Marengo Otero" 2 => "M.J. González-Beato Merino" 3 => "P. García Morrás" 4 => "C. Bueno Marco" 5 => "P. 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Robinson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:5 [ "titulo" => "Roenigk's dermatologic surgery" "paginaInicial" => "210" "paginaFinal" => "215" "edicion" => "3rd ed" "serieFecha" => "2007" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0040" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Utilidade do retalho de avanço e rotação para fechamento de defeitos cutâneos na região malar" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "G. Galimberti" 1 => "D. Ferrario" 2 => "G. Riveiro Casabona" 3 => "L.M. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 74 | 7 | 81 |
| 2024 Octubre | 697 | 48 | 745 |
| 2024 Septiembre | 517 | 32 | 549 |
| 2024 Agosto | 484 | 57 | 541 |
| 2024 Julio | 422 | 28 | 450 |
| 2024 Junio | 364 | 41 | 405 |
| 2024 Mayo | 271 | 36 | 307 |
| 2024 Abril | 277 | 27 | 304 |
| 2024 Marzo | 289 | 34 | 323 |
| 2024 Febrero | 284 | 43 | 327 |
| 2024 Enero | 519 | 47 | 566 |
| 2023 Diciembre | 448 | 32 | 480 |
| 2023 Noviembre | 392 | 36 | 428 |
| 2023 Octubre | 306 | 30 | 336 |
| 2023 Septiembre | 270 | 33 | 303 |
| 2023 Agosto | 237 | 21 | 258 |
| 2023 Julio | 191 | 46 | 237 |
| 2023 Junio | 219 | 29 | 248 |
| 2023 Mayo | 242 | 31 | 273 |
| 2023 Abril | 152 | 30 | 182 |
| 2023 Marzo | 187 | 23 | 210 |
| 2023 Febrero | 247 | 21 | 268 |
| 2023 Enero | 154 | 30 | 184 |
| 2022 Diciembre | 121 | 45 | 166 |
| 2022 Noviembre | 68 | 25 | 93 |
| 2022 Octubre | 41 | 30 | 71 |
| 2022 Septiembre | 48 | 43 | 91 |
| 2022 Agosto | 19 | 32 | 51 |
| 2022 Julio | 39 | 41 | 80 |
| 2022 Junio | 17 | 21 | 38 |
| 2022 Mayo | 103 | 54 | 157 |
| 2022 Abril | 176 | 48 | 224 |
| 2022 Marzo | 161 | 73 | 234 |
| 2022 Febrero | 173 | 25 | 198 |
| 2022 Enero | 224 | 48 | 272 |
| 2021 Diciembre | 138 | 46 | 184 |
| 2021 Noviembre | 163 | 47 | 210 |
| 2021 Octubre | 111 | 59 | 170 |
| 2021 Septiembre | 95 | 77 | 172 |
| 2021 Agosto | 131 | 34 | 165 |
| 2021 Julio | 98 | 36 | 134 |
| 2021 Junio | 124 | 27 | 151 |
| 2021 Mayo | 106 | 33 | 139 |
| 2021 Abril | 204 | 59 | 263 |
| 2021 Marzo | 152 | 29 | 181 |
| 2021 Febrero | 113 | 36 | 149 |
| 2021 Enero | 62 | 17 | 79 |
| 2020 Diciembre | 63 | 19 | 82 |
| 2020 Noviembre | 39 | 22 | 61 |
| 2020 Octubre | 38 | 14 | 52 |
| 2020 Septiembre | 46 | 17 | 63 |
| 2020 Agosto | 22 | 19 | 41 |
| 2020 Julio | 27 | 15 | 42 |
| 2020 Junio | 40 | 38 | 78 |
| 2020 Mayo | 42 | 21 | 63 |
| 2020 Abril | 35 | 14 | 49 |
| 2020 Marzo | 37 | 16 | 53 |
| 2020 Febrero | 8 | 7 | 15 |
| 2020 Enero | 4 | 9 | 13 |
| 2019 Diciembre | 8 | 1 | 9 |
| 2019 Noviembre | 3 | 0 | 3 |
| 2019 Septiembre | 10 | 1 | 11 |
| 2019 Agosto | 4 | 0 | 4 |
| 2019 Julio | 4 | 10 | 14 |
| 2019 Junio | 4 | 1 | 5 |
| 2019 Mayo | 9 | 8 | 17 |
| 2019 Abril | 2 | 23 | 25 |
| 2019 Marzo | 0 | 7 | 7 |
| 2019 Febrero | 5 | 2 | 7 |
| 2019 Enero | 0 | 5 | 5 |
| 2018 Diciembre | 4 | 0 | 4 |
| 2018 Noviembre | 4 | 0 | 4 |
| 2018 Octubre | 5 | 0 | 5 |
| 2018 Septiembre | 5 | 0 | 5 |
| 2018 Agosto | 0 | 4 | 4 |
| 2018 Julio | 0 | 3 | 3 |
| 2018 Junio | 0 | 1 | 1 |
| 2018 Mayo | 0 | 12 | 12 |
| 2018 Abril | 0 | 1 | 1 |
| 2018 Marzo | 2 | 5 | 7 |
| 2018 Febrero | 58 | 15 | 73 |
| 2018 Enero | 69 | 4 | 73 |
| 2017 Diciembre | 73 | 11 | 84 |
| 2017 Noviembre | 52 | 14 | 66 |
| 2017 Octubre | 54 | 17 | 71 |
| 2017 Septiembre | 43 | 7 | 50 |
| 2017 Agosto | 69 | 10 | 79 |
| 2017 Julio | 35 | 20 | 55 |
| 2017 Junio | 56 | 8 | 64 |
| 2017 Mayo | 42 | 11 | 53 |
| 2017 Abril | 33 | 13 | 46 |
| 2017 Marzo | 14 | 15 | 29 |
| 2017 Febrero | 15 | 15 | 30 |
| 2017 Enero | 15 | 7 | 22 |
| 2016 Diciembre | 29 | 27 | 56 |
| 2016 Noviembre | 41 | 19 | 60 |
| 2016 Octubre | 29 | 16 | 45 |
| 2016 Septiembre | 0 | 6 | 6 |
| 2016 Agosto | 0 | 9 | 9 |
| 2016 Julio | 0 | 1 | 1 |
| 2016 Junio | 4 | 4 | 8 |
| 2016 Mayo | 0 | 2 | 2 |
| 2016 Abril | 1 | 1 | 2 |
| 2016 Marzo | 0 | 9 | 9 |
| 2016 Febrero | 0 | 10 | 10 |
| 2016 Enero | 0 | 9 | 9 |
| 2015 Diciembre | 0 | 1 | 1 |
| 2015 Noviembre | 0 | 4 | 4 |
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