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The resulting skin defects were reconstructed using logarithmic spiral flaps&#46; The patients were 5 women and 10 men&#44; with a mean age of 57 years&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Surgical Technique</span><p id="par0020" class="elsevierStylePara elsevierViewall">The most important aspect is a correct design of the flap&#44; which must extend along approximately half of the perimeter of a theoretical circumference&#46; The pedicle can be superior or inferior&#44; and each one of the these can&#44; in turn&#44; use medial rotation &#40;parallel to the dorsum of the nose&#41; or lateral rotation &#40;perpendicular to the dorsum of the nose&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">For circular defects&#44; the first step is to draw the vertical and horizontal axes of the defect&#44; which will have the same length &#40;X&#41;&#46; The tangent of the superior border of the defect is then drawn parallel to the horizontal axis&#44; and the vertical axis is extended superiorly or inferiorly&#44; depending on the design of the pedicle&#46; Three points are required to design the spiral&#58; the first is the point of intersection between the vertical axis and the inferior border of the defect&#59; the second is the point on the tangent at a distance of 1&#46;15X from the vertical axis&#59; the third is the point on the prolongation of the vertical axis&#44; situated at 1&#46;3X from the superior border of the defect &#40;<a class="elsevierStyleCrossRefs" href="#fig0010">Figs&#46; 2 and 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">After drawing the design&#44; the flap is dissected in the subcutaneous plane&#44; and the distal end is rotated on itself to cover the defect&#46; A subcutaneous stitch of 4&#47;0 or 5&#47;0 polyglycolic acid &#40;Dexon&#41; is placed to attach the proximal part of the pedicle to the middle of the semicircle of the design&#46; No sutures should be placed at the tip of the flap as this could compromise the blood supply&#46; A 6&#47;0 silk suture is then used to close the remaining defect&#44; displacing the flap to adapt it to the peri-incisional skin &#40;<a class="elsevierStyleCrossRefs" href="#fig0020">Figs&#46; 4&#8211;8</a>&#41;&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="fig0030"></elsevierMultimedia><elsevierMultimedia ident="fig0035"></elsevierMultimedia><elsevierMultimedia ident="fig0040"></elsevierMultimedia></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0035" class="elsevierStylePara elsevierViewall">The cosmetic result after surgical reconstruction was adequate&#44; and none of the patients required additional treatment to improve the appearance of the scar&#46; Respiratory function was preserved in all cases &#40;<a class="elsevierStyleCrossRefs" href="#fig0020">Figs&#46; 4&#8211;8</a>&#41;&#46; The main limitation observed was a minimal retraction of the nasal ala after surgery in 1 patient&#59; this occurred because the pedicle was initiated on the medial border of the defect rather than on its inferior or superior border&#46; In some patients a small central area was left open at the point of maximum tension to avoid vascular compromise of the displaced tissue&#46; These areas healed correctly and spontaneously within a few days &#40;<a class="elsevierStyleCrossRefs" href="#fig0020">Figs&#46; 4 and 5</a>&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">Primary vertical closure is an appropriate option for the reconstruction of small defects of the nasal ala&#59; however&#44; this is not possible for larger lesions because of the high likelihood of subsequent asymmetry due to traction on the ala&#46; Although second-intention healing produces acceptable results in concave areas of the external nose&#44; hypertrophic scars can develop in convex areas&#44; with traction on the ala giving rise to asymmetry&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> Pipitone and Gloster<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> proposed a combination of partial primary closure and healing by second intention as an option for the reconstruction of defects of the nasal ala&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The cosmetic results of skin grafts to the nasal ala are usually poorer&#44; with healing defects or persistent edema&#46; In a series of 168 patients with small defects on the nasal ala that were reconstructed with full-thickness skin grafts&#44; 93 required an intervention to improve the cosmetic appearance&#58; 67 by triamcinolone acetonide injection&#44; 14 by a combination of triamcinolone injections and laser&#44; and 12 by laser alone&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The Limberg and Dufourmentel transposition flap is useful to cover geometric rhomboid defects&#44; but it is not so effective in round or oval defects&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> Digitiform and lobed flaps that transpose adjacent skin frequently produce lumps&#44; with a very unsightly trap-door effect&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The spiral flap is a modification of the rotation flap and achieves better functional and cosmetic results&#46; Humphreys<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> proposed the reconstruction of small defects of the nasal ala using a spiral flap in which the incision was made along the nasal sulcus&#46; In some patients in that study&#44; their technique gave rise to retraction and asymmetry of the ala that required triamcinolone injections in the postoperative period for correction&#46; Stoner and Stoner<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> described another variant of the spiral flap in which the risk of retraction was reduced by making the incision along one of the borders of the ala&#44; thus taking advantage of the surrounding skin to increase freedom of movement during reconstruction of the defect&#46; However&#44; the total length of the incision sometimes had to be longer&#44; reaching the nasolabial fold&#44; which increased the risk of traction on the ala and an unacceptable cosmetic result&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">We present a series of patients with nasal defects reconstructed using spiral flaps for which&#44; as in the report by Stoner and Stoner&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> the incision was made along one of the borders of the nasal ala&#46; However&#44; in contrast to those authors&#44; we used the technique described by Mahlberg et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a> in which the flap had a logarithmic design that produced a spiral with a diameter that progressively increased along the length of the flap rather than remaining constant&#46; This increases the surface area of the flap and creates a larger vascular pedicle&#44; reducing the risk of necrosis&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Although there are 4 options for the logarithmic spiral flap&#44; the use of an inferior pedicle is much more limited than a superior pedicle&#44; as it is only indicated for defects high up on the nose&#44; at a distance from the nasal ala&#46; Also&#44; depending on the size and design&#44; an inferior pedicle can give rise to traction on the ala and produce asymmetry&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">During reconstruction using a logarithmic spiral flap&#44; the most important factor is the initial design&#44; which consists of drawing the point of intersection between the vertical axis &#40;X&#41; and the inferior border of the defect&#44; another point of intersection on the tangent of the superior border&#44; situated at a distance of 1&#46;15X from the vertical axis&#44; and a third point on the prolongation of the vertical axis&#44; at a distance of 1&#46;3X from the superior border of the defect&#46; These 3 points will guide the design of the logarithmic spiral&#44; as they ensure a progressive increase in the radius from the distal end of the flap to its base&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Likewise&#44; it should be noted that&#44; depending on the size and site of the defect&#44; as well as on the nasal physionomy of each patient&#44; the design cannot always be initiated at the superior or inferior border of the defect&#44; but rather it must occasionally be more medial or lateral&#59; in all cases&#44; the flap must occupy half the perimeter of a theoretical circumference &#40;<a class="elsevierStyleCrossRefs" href="#fig0010">Figs&#46; 2 and 3</a>&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The matter of leaving a minimal area unsutured&#44; coinciding with the concave area of the center of the defect&#44; is not a problem&#44; as this will heal correctly by second intention&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">In summary&#44; we have proposed the logarithmic spiral flap as a very useful&#44; cosmetically acceptable&#44; and functional alternative for the closure of circular or oval defects on the external nose&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Ethical disclosures</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Protection of human and animal subjects&#46;</span><p id="par0090" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this research&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Confidentiality of data</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors declare that no private patient data are disclosed in this article&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Right to privacy and informed consent</span><p id="par0100" class="elsevierStylePara elsevierViewall">The authors obtained informed consent from the patients and&#47;or subjects referred to in this article&#46; This document is held by the corresponding author&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflicts of Interest</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
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          "identificador" => "xres561382"
          "titulo" => "Abstract"
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              "identificador" => "abst0005"
              "titulo" => "Introduction"
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            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Materials and methods"
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              "identificador" => "abst0015"
              "titulo" => "Results"
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        1 => array:2 [
          "identificador" => "xpalclavsec577800"
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        2 => array:3 [
          "identificador" => "xres561383"
          "titulo" => "Resumen"
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              "titulo" => "Introducci&#243;n"
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            1 => array:2 [
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              "titulo" => "Materiales y m&#233;todos"
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            2 => array:2 [
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          "identificador" => "xpalclavsec577801"
          "titulo" => "Palabras clave"
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        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
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        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Material and Methods"
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            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Surgical Technique"
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          "identificador" => "sec0020"
          "titulo" => "Results"
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          "titulo" => "Ethical disclosures"
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              "identificador" => "sec0035"
              "titulo" => "Protection of human and animal subjects&#46;"
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              "identificador" => "sec0040"
              "titulo" => "Confidentiality of data"
            ]
            2 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Right to privacy and informed consent"
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        9 => array:2 [
          "identificador" => "sec0050"
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          "titulo" => "References"
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    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2015-02-20"
    "fechaAceptado" => "2015-05-19"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec577800"
          "palabras" => array:5 [
            0 => "Surgery"
            1 => "Nonmelanoma skin cancer"
            2 => "Logarithmic spiral flap"
            3 => "Rotation flap"
            4 => "Transposition flap"
          ]
        ]
      ]
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
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          "palabras" => array:5 [
            0 => "Cirug&#237;a"
            1 => "C&#225;ncer cut&#225;neo"
            2 => "Colgajo en espiral logar&#237;tmica"
            3 => "Colgajo de rotaci&#243;n"
            4 => "Colgajo de transposici&#243;n"
          ]
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    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A large number of flaps&#44; particularly rotation and transposition flaps&#44; have been described for the closure of skin defects left by oncologic surgery of the nose&#46; The logarithmic spiral flap is a variant of the rotation flap&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We present a series of 15 patients with different types of skin tumor on the nose&#46; The skin defect resulting from excision of the tumor by micrographic surgery was reconstructed using various forms of the logarithmic spiral flap&#46; There are 3 essential aspects to flap design&#58; commencement of the pedicle at the upper or lower border of the wound&#44; a width of the distal end of the flap equal to the vertical diameter of the defect&#44; and a progressive increase in the radius of the spiral from the distal end of the flap to its base&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The cosmetic and functional results of surgical reconstruction were satisfactory&#44; and no patient required additional treatment to improve scar appearance&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The logarithmic spiral flap is useful for the closure of circular or oval defects situated on the lateral surface of the nose and nasal ala&#46; The flap initiates at one of the borders of the wound as a pedicle with a radius that increases progressively to create a spiral&#46; We propose the logarithmic spiral flap as an excellent option for the closure of circular or oval defects of the nose&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Materials and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusion"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Para cerrar defectos cut&#225;neos secundarios a cirug&#237;a oncol&#243;gica en la pir&#225;mide nasal se han descrito un elevado n&#250;mero de colgajos&#44; entre los que destacan los de rotaci&#243;n y transposici&#243;n&#46; El colgajo en espiral logar&#237;tmica se considera una variante del colgajo de rotaci&#243;n&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Materiales y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Presentamos una serie de 15 pacientes con diferentes tipos de neoplasias cut&#225;neas en la pir&#225;mide nasal en los que el defecto cut&#225;neo tras la ex&#233;resis mediante cirug&#237;a controlada al microscopio fue reconstruido mediante diferentes opciones de colgajo en espiral logar&#237;tmica&#46; En el dise&#241;o del colgajo existen 3 aspectos esenciales&#58; iniciar el ped&#237;culo en el borde superior o inferior de la herida&#44; procurar que la anchura del extremo distal sea equivalente al di&#225;metro vertical del defecto y aumentar progresivamente el radio desde el extremo distal del colgajo hasta su base&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Los resultados est&#233;tico y funcional tras la reconstrucci&#243;n quir&#250;rgica fueron adecuados&#44; y ning&#250;n paciente requiri&#243; tratamientos adicionales para mejorar el aspecto de la cicatriz&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El colgajo en espiral logar&#237;tmica es &#250;til en el cierre de defectos con morfolog&#237;a circular u ovalada localizados en el ala y lateral nasal&#44; y se dise&#241;a desde uno de los bordes de la herida como un ped&#237;culo que&#44; a modo de espiral&#44; va aumentando progresivamente su radio&#46; Proponemos el colgajo en espiral logar&#237;tmica como una opci&#243;n excelente por un buen resultado est&#233;tico en el cierre de defectos circulares u ovalados de la pir&#225;mide nasal&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introducci&#243;n"
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          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Materiales y m&#233;todos"
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          2 => array:2 [
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            "titulo" => "Resultados"
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    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Moreno-Artero E&#44; Redondo P&#46; Colgajo en espiral logar&#237;tmica para defectos circulares u ovalados en superficie lateral y ala nasal&#46; Una serie de 15 casos&#46; Actas Dermosifiliogr&#46; 2015&#59;106&#58;658&#8211;665&#46;</p>"
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    ]
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      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
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        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Superior pedicle&#58; A&#44; Lateral rotation&#46; B&#44; Medial rotation&#46; Inferior pedicle&#58; C&#44; Lateral rotation&#46; D&#44; Medial rotation&#46;</p>"
        ]
      ]
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        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
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            "Tamanyo" => 200825
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        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">A&#44; The vertical and horizontal axes of the defect are drawn&#59; these axes are of the same length &#40;X&#41;&#46; B&#44; The tangent is drawn across the superior border of the defect&#44; parallel to the horizontal axis&#59; the vertical axis of the defect is extended&#46; C&#44; The point of intersection between the vertical axis and the inferior border of the defect is marked&#46; D&#44; The second point is situated on the tangent at a distance of 1&#46;15X from the vertical axis&#46; E&#44; The third point of intersection is marked on the prolongation of the vertical axis&#44; at a distance of 1&#46;3X from the superior border of the defect&#46; F&#44; The logarithmic spiral is designed using these 3 points&#46;</p>"
        ]
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        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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        "figura" => array:1 [
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            "Tamanyo" => 64421
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Same design as in the previous figure but starting the flap at a different point&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "fig0020"
        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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        "figura" => array:1 [
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            "imagen" => "gr4.jpeg"
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            "Tamanyo" => 555605
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        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">A&#44; Basal cell carcinoma on the left nasal ala&#46; B&#44; Design of a logarithmic spiral flap with a superior pedicle&#46; C&#44; Flap dissected in the subcutaneous plane&#46; D&#44; After medial rotation of the flap&#44; it was sutured using a 4&#47;0 polyglycolic acid suture &#40;Dexon&#41; and 6&#47;0 silk&#46; A small concave area was left open&#46; This healed correctly within a few days by second intention&#46; E&#44; Result at 24<span class="elsevierStyleHsp" style=""></span>hours&#46; F&#44; Appearance at 6 months&#46;</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "fig0025"
        "etiqueta" => "Figure 5"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr5.jpeg"
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            "Tamanyo" => 560534
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">A&#44; Basal cell carcinoma on the lateral surface of the nose&#46; B&#44; Logarithmic spiral flap with a superior pedicle&#46; C&#44; An oval defect was left on the nasal ala&#46; D&#44; The flap was dissected in a deep plane&#46; E&#44; Medial rotation of the flap&#44; parallel to the dorsum of the nose&#44; and suture with a 4&#47;0 polyglycolic acid suture &#40;Dexon&#41; and 6&#47;0 silk&#46; F&#44; Result at 24<span class="elsevierStyleHsp" style=""></span>hours&#46;</p>"
        ]
      ]
      5 => array:7 [
        "identificador" => "fig0030"
        "etiqueta" => "Figure 6"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr6.jpeg"
            "Alto" => 1001
            "Ancho" => 1639
            "Tamanyo" => 344042
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">A&#44; Basal cell carcinoma on the lateral surface of the nose&#46; B&#44; Circular defect and design of a logarithmic spiral flap with a superior pedicle&#46; C&#44; Lateral rotation of the flap&#44; perpendicular to the dorsum of the nose&#46; D and E&#44; Appearance at 1 year&#46;</p>"
        ]
      ]
      6 => array:7 [
        "identificador" => "fig0035"
        "etiqueta" => "Figure 7"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr7.jpeg"
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            "Ancho" => 1743
            "Tamanyo" => 540516
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">A&#44; Basal cell carcinoma on the lateral surface of the nose&#46; B&#44; A circular defect&#46; C&#44; Medial rotation of the flap&#44; parallel to the dorsum of the nose&#46; D&#44; Suture using a 4&#47;0 polyglycolic acid suture &#40;Dexon&#41; and 6&#47;0 silk&#46; E&#44; Result at 24<span class="elsevierStyleHsp" style=""></span>hours&#46; F&#44; Appearance at 2 months&#46;</p>"
        ]
      ]
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        "etiqueta" => "Figure 8"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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        "figura" => array:1 [
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            "imagen" => "gr8.jpeg"
            "Alto" => 1473
            "Ancho" => 1500
            "Tamanyo" => 468207
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ORIGINAL ARTICLES
Logarithmic Spiral Flap for Circular or Oval Defects on the Lateral Surface of the Nose and Nasal Ala: A Series of 15 Cases
Colgajo en espiral logarítmica para defectos circulares u ovalados en superficie lateral y ala nasal. Una serie de 15 casos
E. Moreno-Artero, P. Redondo
Autor para correspondencia
predondo@unav.es

Corresponding author.
Departamento de Dermatología Médico-Quirúrgica y Venereología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">A&#44; The vertical and horizontal axes of the defect are drawn&#59; these axes are of the same length &#40;X&#41;&#46; B&#44; The tangent is drawn across the superior border of the defect&#44; parallel to the horizontal axis&#59; the vertical axis of the defect is extended&#46; C&#44; The point of intersection between the vertical axis and the inferior border of the defect is marked&#46; D&#44; The second point is situated on the tangent at a distance of 1&#46;15X from the vertical axis&#46; E&#44; The third point of intersection is marked on the prolongation of the vertical axis&#44; at a distance of 1&#46;3X from the superior border of the defect&#46; F&#44; The logarithmic spiral is designed using these 3 points&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">There are a number of surgical options for the reconstruction of small circular or oval defects on the external nose&#46; The most relevant are healing by second intention&#44; primary closure&#44; partial or full-thickness skin grafts&#44; lobed and geometric transposition flaps&#44; and rotation flaps&#46; The rotation flaps include a type called the spiral flap&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The logarithmic spiral flap is designed starting at one of the borders of the wound as a pedicle whose radius progressively increases in the form of a spiral&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and Methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">We present a series of 15 patients who underwent excision of different types of skin tumor on the external nose using micrographic surgery between January 2011 and January 2015 &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The resulting skin defects were reconstructed using logarithmic spiral flaps&#46; The patients were 5 women and 10 men&#44; with a mean age of 57 years&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Surgical Technique</span><p id="par0020" class="elsevierStylePara elsevierViewall">The most important aspect is a correct design of the flap&#44; which must extend along approximately half of the perimeter of a theoretical circumference&#46; The pedicle can be superior or inferior&#44; and each one of the these can&#44; in turn&#44; use medial rotation &#40;parallel to the dorsum of the nose&#41; or lateral rotation &#40;perpendicular to the dorsum of the nose&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">For circular defects&#44; the first step is to draw the vertical and horizontal axes of the defect&#44; which will have the same length &#40;X&#41;&#46; The tangent of the superior border of the defect is then drawn parallel to the horizontal axis&#44; and the vertical axis is extended superiorly or inferiorly&#44; depending on the design of the pedicle&#46; Three points are required to design the spiral&#58; the first is the point of intersection between the vertical axis and the inferior border of the defect&#59; the second is the point on the tangent at a distance of 1&#46;15X from the vertical axis&#59; the third is the point on the prolongation of the vertical axis&#44; situated at 1&#46;3X from the superior border of the defect &#40;<a class="elsevierStyleCrossRefs" href="#fig0010">Figs&#46; 2 and 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">After drawing the design&#44; the flap is dissected in the subcutaneous plane&#44; and the distal end is rotated on itself to cover the defect&#46; A subcutaneous stitch of 4&#47;0 or 5&#47;0 polyglycolic acid &#40;Dexon&#41; is placed to attach the proximal part of the pedicle to the middle of the semicircle of the design&#46; No sutures should be placed at the tip of the flap as this could compromise the blood supply&#46; A 6&#47;0 silk suture is then used to close the remaining defect&#44; displacing the flap to adapt it to the peri-incisional skin &#40;<a class="elsevierStyleCrossRefs" href="#fig0020">Figs&#46; 4&#8211;8</a>&#41;&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="fig0030"></elsevierMultimedia><elsevierMultimedia ident="fig0035"></elsevierMultimedia><elsevierMultimedia ident="fig0040"></elsevierMultimedia></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0035" class="elsevierStylePara elsevierViewall">The cosmetic result after surgical reconstruction was adequate&#44; and none of the patients required additional treatment to improve the appearance of the scar&#46; Respiratory function was preserved in all cases &#40;<a class="elsevierStyleCrossRefs" href="#fig0020">Figs&#46; 4&#8211;8</a>&#41;&#46; The main limitation observed was a minimal retraction of the nasal ala after surgery in 1 patient&#59; this occurred because the pedicle was initiated on the medial border of the defect rather than on its inferior or superior border&#46; In some patients a small central area was left open at the point of maximum tension to avoid vascular compromise of the displaced tissue&#46; These areas healed correctly and spontaneously within a few days &#40;<a class="elsevierStyleCrossRefs" href="#fig0020">Figs&#46; 4 and 5</a>&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">Primary vertical closure is an appropriate option for the reconstruction of small defects of the nasal ala&#59; however&#44; this is not possible for larger lesions because of the high likelihood of subsequent asymmetry due to traction on the ala&#46; Although second-intention healing produces acceptable results in concave areas of the external nose&#44; hypertrophic scars can develop in convex areas&#44; with traction on the ala giving rise to asymmetry&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> Pipitone and Gloster<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> proposed a combination of partial primary closure and healing by second intention as an option for the reconstruction of defects of the nasal ala&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The cosmetic results of skin grafts to the nasal ala are usually poorer&#44; with healing defects or persistent edema&#46; In a series of 168 patients with small defects on the nasal ala that were reconstructed with full-thickness skin grafts&#44; 93 required an intervention to improve the cosmetic appearance&#58; 67 by triamcinolone acetonide injection&#44; 14 by a combination of triamcinolone injections and laser&#44; and 12 by laser alone&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The Limberg and Dufourmentel transposition flap is useful to cover geometric rhomboid defects&#44; but it is not so effective in round or oval defects&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> Digitiform and lobed flaps that transpose adjacent skin frequently produce lumps&#44; with a very unsightly trap-door effect&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The spiral flap is a modification of the rotation flap and achieves better functional and cosmetic results&#46; Humphreys<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> proposed the reconstruction of small defects of the nasal ala using a spiral flap in which the incision was made along the nasal sulcus&#46; In some patients in that study&#44; their technique gave rise to retraction and asymmetry of the ala that required triamcinolone injections in the postoperative period for correction&#46; Stoner and Stoner<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> described another variant of the spiral flap in which the risk of retraction was reduced by making the incision along one of the borders of the ala&#44; thus taking advantage of the surrounding skin to increase freedom of movement during reconstruction of the defect&#46; However&#44; the total length of the incision sometimes had to be longer&#44; reaching the nasolabial fold&#44; which increased the risk of traction on the ala and an unacceptable cosmetic result&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">We present a series of patients with nasal defects reconstructed using spiral flaps for which&#44; as in the report by Stoner and Stoner&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> the incision was made along one of the borders of the nasal ala&#46; However&#44; in contrast to those authors&#44; we used the technique described by Mahlberg et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a> in which the flap had a logarithmic design that produced a spiral with a diameter that progressively increased along the length of the flap rather than remaining constant&#46; This increases the surface area of the flap and creates a larger vascular pedicle&#44; reducing the risk of necrosis&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Although there are 4 options for the logarithmic spiral flap&#44; the use of an inferior pedicle is much more limited than a superior pedicle&#44; as it is only indicated for defects high up on the nose&#44; at a distance from the nasal ala&#46; Also&#44; depending on the size and design&#44; an inferior pedicle can give rise to traction on the ala and produce asymmetry&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">During reconstruction using a logarithmic spiral flap&#44; the most important factor is the initial design&#44; which consists of drawing the point of intersection between the vertical axis &#40;X&#41; and the inferior border of the defect&#44; another point of intersection on the tangent of the superior border&#44; situated at a distance of 1&#46;15X from the vertical axis&#44; and a third point on the prolongation of the vertical axis&#44; at a distance of 1&#46;3X from the superior border of the defect&#46; These 3 points will guide the design of the logarithmic spiral&#44; as they ensure a progressive increase in the radius from the distal end of the flap to its base&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Likewise&#44; it should be noted that&#44; depending on the size and site of the defect&#44; as well as on the nasal physionomy of each patient&#44; the design cannot always be initiated at the superior or inferior border of the defect&#44; but rather it must occasionally be more medial or lateral&#59; in all cases&#44; the flap must occupy half the perimeter of a theoretical circumference &#40;<a class="elsevierStyleCrossRefs" href="#fig0010">Figs&#46; 2 and 3</a>&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The matter of leaving a minimal area unsutured&#44; coinciding with the concave area of the center of the defect&#44; is not a problem&#44; as this will heal correctly by second intention&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">In summary&#44; we have proposed the logarithmic spiral flap as a very useful&#44; cosmetically acceptable&#44; and functional alternative for the closure of circular or oval defects on the external nose&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Ethical disclosures</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Protection of human and animal subjects&#46;</span><p id="par0090" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this research&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Confidentiality of data</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors declare that no private patient data are disclosed in this article&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Right to privacy and informed consent</span><p id="par0100" class="elsevierStylePara elsevierViewall">The authors obtained informed consent from the patients and&#47;or subjects referred to in this article&#46; This document is held by the corresponding author&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflicts of Interest</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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              "titulo" => "Conclusi&#243;n"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec577801"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Material and Methods"
          "secciones" => array:1 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Surgical Technique"
            ]
          ]
        ]
        6 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Results"
        ]
        7 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Discussion"
        ]
        8 => array:3 [
          "identificador" => "sec0030"
          "titulo" => "Ethical disclosures"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Protection of human and animal subjects&#46;"
            ]
            1 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Confidentiality of data"
            ]
            2 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Right to privacy and informed consent"
            ]
          ]
        ]
        9 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Conflicts of Interest"
        ]
        10 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2015-02-20"
    "fechaAceptado" => "2015-05-19"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec577800"
          "palabras" => array:5 [
            0 => "Surgery"
            1 => "Nonmelanoma skin cancer"
            2 => "Logarithmic spiral flap"
            3 => "Rotation flap"
            4 => "Transposition flap"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec577801"
          "palabras" => array:5 [
            0 => "Cirug&#237;a"
            1 => "C&#225;ncer cut&#225;neo"
            2 => "Colgajo en espiral logar&#237;tmica"
            3 => "Colgajo de rotaci&#243;n"
            4 => "Colgajo de transposici&#243;n"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A large number of flaps&#44; particularly rotation and transposition flaps&#44; have been described for the closure of skin defects left by oncologic surgery of the nose&#46; The logarithmic spiral flap is a variant of the rotation flap&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We present a series of 15 patients with different types of skin tumor on the nose&#46; The skin defect resulting from excision of the tumor by micrographic surgery was reconstructed using various forms of the logarithmic spiral flap&#46; There are 3 essential aspects to flap design&#58; commencement of the pedicle at the upper or lower border of the wound&#44; a width of the distal end of the flap equal to the vertical diameter of the defect&#44; and a progressive increase in the radius of the spiral from the distal end of the flap to its base&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The cosmetic and functional results of surgical reconstruction were satisfactory&#44; and no patient required additional treatment to improve scar appearance&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The logarithmic spiral flap is useful for the closure of circular or oval defects situated on the lateral surface of the nose and nasal ala&#46; The flap initiates at one of the borders of the wound as a pedicle with a radius that increases progressively to create a spiral&#46; We propose the logarithmic spiral flap as an excellent option for the closure of circular or oval defects of the nose&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Materials and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusion"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Para cerrar defectos cut&#225;neos secundarios a cirug&#237;a oncol&#243;gica en la pir&#225;mide nasal se han descrito un elevado n&#250;mero de colgajos&#44; entre los que destacan los de rotaci&#243;n y transposici&#243;n&#46; El colgajo en espiral logar&#237;tmica se considera una variante del colgajo de rotaci&#243;n&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Materiales y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Presentamos una serie de 15 pacientes con diferentes tipos de neoplasias cut&#225;neas en la pir&#225;mide nasal en los que el defecto cut&#225;neo tras la ex&#233;resis mediante cirug&#237;a controlada al microscopio fue reconstruido mediante diferentes opciones de colgajo en espiral logar&#237;tmica&#46; En el dise&#241;o del colgajo existen 3 aspectos esenciales&#58; iniciar el ped&#237;culo en el borde superior o inferior de la herida&#44; procurar que la anchura del extremo distal sea equivalente al di&#225;metro vertical del defecto y aumentar progresivamente el radio desde el extremo distal del colgajo hasta su base&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Los resultados est&#233;tico y funcional tras la reconstrucci&#243;n quir&#250;rgica fueron adecuados&#44; y ning&#250;n paciente requiri&#243; tratamientos adicionales para mejorar el aspecto de la cicatriz&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El colgajo en espiral logar&#237;tmica es &#250;til en el cierre de defectos con morfolog&#237;a circular u ovalada localizados en el ala y lateral nasal&#44; y se dise&#241;a desde uno de los bordes de la herida como un ped&#237;culo que&#44; a modo de espiral&#44; va aumentando progresivamente su radio&#46; Proponemos el colgajo en espiral logar&#237;tmica como una opci&#243;n excelente por un buen resultado est&#233;tico en el cierre de defectos circulares u ovalados de la pir&#225;mide nasal&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introducci&#243;n"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Materiales y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusi&#243;n"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Moreno-Artero E&#44; Redondo P&#46; Colgajo en espiral logar&#237;tmica para defectos circulares u ovalados en superficie lateral y ala nasal&#46; Una serie de 15 casos&#46; Actas Dermosifiliogr&#46; 2015&#59;106&#58;658&#8211;665&#46;</p>"
      ]
    ]
    "multimedia" => array:9 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1303
            "Ancho" => 1000
            "Tamanyo" => 94742
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Superior pedicle&#58; A&#44; Lateral rotation&#46; B&#44; Medial rotation&#46; Inferior pedicle&#58; C&#44; Lateral rotation&#46; D&#44; Medial rotation&#46;</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" => 1899
            "Ancho" => 1900
            "Tamanyo" => 200825
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">A&#44; The vertical and horizontal axes of the defect are drawn&#59; these axes are of the same length &#40;X&#41;&#46; B&#44; The tangent is drawn across the superior border of the defect&#44; parallel to the horizontal axis&#59; the vertical axis of the defect is extended&#46; C&#44; The point of intersection between the vertical axis and the inferior border of the defect is marked&#46; D&#44; The second point is situated on the tangent at a distance of 1&#46;15X from the vertical axis&#46; E&#44; The third point of intersection is marked on the prolongation of the vertical axis&#44; at a distance of 1&#46;3X from the superior border of the defect&#46; F&#44; The logarithmic spiral is designed using these 3 points&#46;</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" => 1270
            "Ancho" => 900
            "Tamanyo" => 64421
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Same design as in the previous figure but starting the flap at a different point&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "fig0020"
        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 1100
            "Ancho" => 1776
            "Tamanyo" => 555605
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">A&#44; Basal cell carcinoma on the left nasal ala&#46; B&#44; Design of a logarithmic spiral flap with a superior pedicle&#46; C&#44; Flap dissected in the subcutaneous plane&#46; D&#44; After medial rotation of the flap&#44; it was sutured using a 4&#47;0 polyglycolic acid suture &#40;Dexon&#41; and 6&#47;0 silk&#46; A small concave area was left open&#46; This healed correctly within a few days by second intention&#46; E&#44; Result at 24<span class="elsevierStyleHsp" style=""></span>hours&#46; F&#44; Appearance at 6 months&#46;</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "fig0025"
        "etiqueta" => "Figure 5"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr5.jpeg"
            "Alto" => 1100
            "Ancho" => 1769
            "Tamanyo" => 560534
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">A&#44; Basal cell carcinoma on the lateral surface of the nose&#46; B&#44; Logarithmic spiral flap with a superior pedicle&#46; C&#44; An oval defect was left on the nasal ala&#46; D&#44; The flap was dissected in a deep plane&#46; E&#44; Medial rotation of the flap&#44; parallel to the dorsum of the nose&#44; and suture with a 4&#47;0 polyglycolic acid suture &#40;Dexon&#41; and 6&#47;0 silk&#46; F&#44; Result at 24<span class="elsevierStyleHsp" style=""></span>hours&#46;</p>"
        ]
      ]
      5 => array:7 [
        "identificador" => "fig0030"
        "etiqueta" => "Figure 6"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr6.jpeg"
            "Alto" => 1001
            "Ancho" => 1639
            "Tamanyo" => 344042
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">A&#44; Basal cell carcinoma on the lateral surface of the nose&#46; B&#44; Circular defect and design of a logarithmic spiral flap with a superior pedicle&#46; C&#44; Lateral rotation of the flap&#44; perpendicular to the dorsum of the nose&#46; D and E&#44; Appearance at 1 year&#46;</p>"
        ]
      ]
      6 => array:7 [
        "identificador" => "fig0035"
        "etiqueta" => "Figure 7"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr7.jpeg"
            "Alto" => 1451
            "Ancho" => 1743
            "Tamanyo" => 540516
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">A&#44; Basal cell carcinoma on the lateral surface of the nose&#46; B&#44; A circular defect&#46; C&#44; Medial rotation of the flap&#44; parallel to the dorsum of the nose&#46; D&#44; Suture using a 4&#47;0 polyglycolic acid suture &#40;Dexon&#41; and 6&#47;0 silk&#46; E&#44; Result at 24<span class="elsevierStyleHsp" style=""></span>hours&#46; F&#44; Appearance at 2 months&#46;</p>"
        ]
      ]
      7 => array:7 [
        "identificador" => "fig0040"
        "etiqueta" => "Figure 8"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr8.jpeg"
            "Alto" => 1473
            "Ancho" => 1500
            "Tamanyo" => 468207
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">A&#44; Basal cell carcinoma on the lateral surface of the nose&#46; B&#44; Flap with a superior pedicle dissected in the subcutaneous plane&#46; C&#44; The flap was rotated perpendicular to the dorsum of the nose&#46; D&#44; Appearance at 8 months&#46;</p>"
        ]
      ]
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        "etiqueta" => "Table 1"
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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">Characteristic&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">Value&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  " align="left" valign="top"><span class="elsevierStyleItalic">Women&#47;men</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#47;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Mean age &#40;range&#41;&#44; y</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">57 &#40;31-84&#41;&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"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Diagnosis</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Basal cell carcinoma&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" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Squamous cell carcinoma&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></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Mean size of the surgical defect &#40;range&#41;&#44; mm</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#40;8-13&#41;&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"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Site of the defect</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Nasal ala &#40;anterior&#44; medial&#44; posterior&#41;&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;1&#44; 6&#44; 1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Alar sulcus &#40;anterior&#44; medial&#44; posterior&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;1&#44; 4&#44; 2&#41;&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"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Superior pedicle</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Lateral rotation&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></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Medial rotation&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></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Inferior pedicle</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Lateral rotation&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></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Medial rotation&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></tr></tbody></table>
                  """
              ]
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                0 => "xTab908836.png"
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Patient Characteristics&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:7 [
            0 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Wound healing by secondary intention&#46; A cosmetic appraisal"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46;A&#46; Zitelli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol&#46;"
                        "fecha" => "1983"
                        "volumen" => "9"
                        "paginaInicial" => "407"
                        "paginaFinal" => "415"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6630602"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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