Videos of Surgical Procedures in Dermatology
Incomplete Cleft Earlobe Reconstruction Using a Z-plasty or Hammock Flap
Reconstrucción de lóbulo rasgado incompleto mediante media z plastia o colgajo en hamaca
E. Vargas-Laguna
, A. Imbernón-Moya, A. Lobato Berezo
Autor para correspondencia
Servicio de Dermatología, Hospital Universitario Severo Ochoa, Madrid, Spain
Leído
7207
Vecesse ha leído el artículo
2145
Total PDF
5062
Total HTML
Compartir estadísticas
array:24 [ "pii" => "S1578219016302153" "issn" => "15782190" "doi" => "10.1016/j.adengl.2016.08.012" "estado" => "S300" "fechaPublicacion" => "2016-11-01" "aid" => "1451" "copyright" => "Elsevier España, S.L.U. and AEDV" "copyrightAnyo" => "2016" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2016;107:775-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 858 "formatos" => array:3 [ "EPUB" => 53 "HTML" => 534 "PDF" => 271 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0001731016301776" "issn" => "00017310" "doi" => "10.1016/j.ad.2016.05.013" "estado" => "S300" "fechaPublicacion" => "2016-11-01" "aid" => "1451" "copyright" => "AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2016;107:775-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 321 "formatos" => array:3 [ "EPUB" => 2 "HTML" => 263 "PDF" => 56 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Vídeos de cirugía dermatológica</span>" "titulo" => "Reconstrucción de lóbulo rasgado incompleto mediante media z plastia o colgajo en hamaca" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "775" "paginaFinal" => "776" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Incomplete Cleft Earlobe Reconstruction Using a Z-plasty or Hammock Flap" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "E. Vargas-Laguna, A. Imbernón-Moya, A. Lobato Berezo" "autores" => array:3 [ 0 => array:2 [ "nombre" => "E." "apellidos" => "Vargas-Laguna" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Imbernón-Moya" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Lobato Berezo" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219016302153" "doi" => "10.1016/j.adengl.2016.08.012" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016302153?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731016301776?idApp=UINPBA000044" "url" => "/00017310/0000010700000009/v1_201611020109/S0001731016301776/v1_201611020109/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1578219016302190" "issn" => "15782190" "doi" => "10.1016/j.adengl.2016.05.024" "estado" => "S300" "fechaPublicacion" => "2016-11-01" "aid" => "1454" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Actas Dermosifiliogr. 2016;107:777-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1118 "formatos" => array:3 [ "EPUB" => 57 "HTML" => 683 "PDF" => 378 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Resident Forum</span>" "titulo" => "Nicotinamide: New Indications in Dermatology" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "777" "paginaFinal" => "778" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "FR - Nuevas indicaciones de nicotinamida en dermatología" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.M. Escudero-Góngora, P. Fernández-Peñas" "autores" => array:2 [ 0 => array:2 [ "nombre" => "M.M." "apellidos" => "Escudero-Góngora" ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Fernández-Peñas" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731016301806" "doi" => "10.1016/j.ad.2016.05.015" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731016301806?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016302190?idApp=UINPBA000044" "url" => "/15782190/0000010700000009/v1_201611010039/S1578219016302190/v1_201611010039/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1578219016301883" "issn" => "15782190" "doi" => "10.1016/j.adengl.2016.08.003" "estado" => "S300" "fechaPublicacion" => "2016-11-01" "aid" => "1341" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2016;107:773-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1016 "formatos" => array:3 [ "EPUB" => 57 "HTML" => 756 "PDF" => 203 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case for Diagnosis</span>" "titulo" => "Periorificial Lesions in a Young Girl" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "773" "paginaFinal" => "774" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Lesiones periorificiales en una niña" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 401 "Ancho" => 975 "Tamanyo" => 78944 ] ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Mayor-Ibarguren, R. Maseda-Pedrero, M. Feito-Rodríguez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Mayor-Ibarguren" ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Maseda-Pedrero" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Feito-Rodríguez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731016000132" "doi" => "10.1016/j.ad.2015.06.017" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731016000132?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016301883?idApp=UINPBA000044" "url" => "/15782190/0000010700000009/v1_201611010039/S1578219016301883/v1_201611010039/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Videos of Surgical Procedures in Dermatology</span>" "titulo" => "Incomplete Cleft Earlobe Reconstruction Using a Z-plasty or Hammock Flap" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "775" "paginaFinal" => "776" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "E. Vargas-Laguna, A. Imbernón-Moya, A. Lobato Berezo" "autores" => array:3 [ 0 => array:4 [ "nombre" => "E." "apellidos" => "Vargas-Laguna" "email" => array:1 [ 0 => "evargaslaguna@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Imbernón-Moya" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Lobato Berezo" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Severo Ochoa, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Reconstrucción de lóbulo rasgado incompleto mediante media z plastia o colgajo en hamaca" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">In cleft earlobes, the split can be complete or incomplete, depending on whether or not the defect reaches the free border of the lobe. There are many reconstruction techniques, from direct closure to classic Z-plasties.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Choice of the appropriate surgical procedure is based on an evaluation of the site of the cleft orifice, symmetry with the contralateral lobe, and possible lengthening of the lobe. It should also be planned whether to maintain the initial orifice or, in contrast, to create a new perforation after the intervention.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In 1996, Abenavoli<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> first described the use of a half Z-plasty to reconstruct complete and incomplete cleft earlobes. The advantage of this technique over the traditional Z-plasty is maintenance of the original orifice and the fact that it is a simple and quick procedure.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> In 1998, Gayiwala<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> described the use of a similar technique for reconstruction of the cleft lobes. This method, which he called the hammock flap, avoided producing a pointed lobe, as can occur after reconstruction with the classic Z-plasty, and left an oblique scar. In complete defects, he added a small L-flap at the free border of the lobe to prevent notches.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The advantages of this technique compared with direct closure were that it has a lower recurrence rate and that the reconstructed lobe has a natural, round silhouette; it was also preferable to the punch technique for lobes with a limited volume of tissue.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">We present the case of an incomplete cleft lobe in a 34-year-old patient. The defect occupied the lower two thirds of the left earlobe and was not associated with lengthening of the lobe. We decided to perform reconstruction using a half Z-plasty or hammock technique, maintaining the original orifice.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Description of the Technique</span><p id="par0030" class="elsevierStylePara elsevierViewall">After designing the flap, local anesthesia is administered with 1% mepivacaine plus 1:200<span class="elsevierStyleHsp" style=""></span>000 epinephrine. A hook is used to hold the lobe in a fixed position. An elliptical incision is made to refresh the borders of the central part of the cleft, where the orifice had split, maintaining the upper part intact. An incision is then made at the extremes of the Z, penetrating through to the posterior surface of the lobe. This creates 2 triangular flaps that are transposed across the central area, embracing the original orifice that is left at the superior end of the incision.</p><p id="par0035" class="elsevierStylePara elsevierViewall">After placing subcutaneous sutures with a 5/0 absorbable material such as polyglactin, suturing of the skin is started on the anterior surface of the lobe, with interrupted sutures with 5/0 monofilament polypropylene. A 3/0 braided silk thread is left in the remaining orifice and the patient is advised to move this thread several times a day for the next 3 weeks, when a small earring can be inserted. Sutures are removed 10 days after the operation.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The procedure is similar in lobes with a complete cleft, performing the Z-plasty at the midpoint of the defect.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Indications</span><p id="par0045" class="elsevierStylePara elsevierViewall">Reconstruction of complete and incomplete earlobe clefts when it is desired to preserve the original orifice.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Contraindications</span><p id="par0050" class="elsevierStylePara elsevierViewall">Very long earlobes with a (relative) excess of tissue.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Complications</span><p id="par0055" class="elsevierStylePara elsevierViewall">An unsightly scar may remain in some patients and, as with any Z-plasty, necrosis of the tips of the flaps can occur. As there is no tension, subcutaneous suture, which could compromise the tips of the flaps, is not necessary.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Another possible complication is recurrence of the cleft lobe, although this complication is more likely when the original orifice is maintained during the reconstruction. This stepped closure provides considerable support to the orifice.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="par0065" class="elsevierStylePara elsevierViewall">The modified Z-plasty technique or hammock flap is a simple and rapid reconstruction technique for cleft earlobes and has a good cosmetic result. According to some studies, maintenance of the original orifice leads to greater patient satisfaction.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> The procedure is useful for both complete and incomplete earlobe clefts; preservation of the original orifice will maintain symmetry with the orifice in the other lobe. Additionally, when there is a complete cleft, this technique prevents the appearance of notches, as can occur with any Z-plasty.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of Interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Description of the Technique" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Indications" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Contraindications" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Complications" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Conclusions" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of Interest" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Vargas-Laguna E, Imbernón-Moya A, Lobato Berezo A. Reconstrucción de lóbulo rasgado incompleto mediante media z plastia o colgajo en hamaca. Actas Dermosifiliogr. 2016;107:775–776.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0080" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0045" ] ] ] ] "multimedia" => array:1 [ 0 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc1.mp4" "ficheroTamanyo" => 37638097 "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" => "Split earlobe: Repair using a half Z-plasty technique" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "F.M. Abenavoli" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Plast Reconstr Surg" "fecha" => "1996" "volumen" => "98" "paginaInicial" => "372" "paginaFinal" => "373" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8764733" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Repair of cleft earlobe using double opposing Z-plasty" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R. Agarwal" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Plast Recosntr Surg" "fecha" => "1998" "volumen" => "102" "paginaInicial" => "1759" "paginaFinal" => "1760" "itemHostRev" => array:3 [ "pii" => "S0735109799002132" "estado" => "S300" "issn" => "07351097" ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Repair of the split earlobe using a half Z-plasty" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "K. Gajiwala" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Plast Reconstr Surg" "fecha" => "1998" "volumen" => "101" "paginaInicial" => "855" "paginaFinal" => "856" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9500409" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgical pearl: Repair of partially torn earlobes-Punch technique versus conversion to complete tear" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Nikko" 1 => "S. Hsu" 2 => "L.T. Quan" 3 => "S.S. Greenbaum" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1067/mjd.2000.105562" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2000" "volumen" => "43" "paginaInicial" => "99" "paginaFinal" => "101" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10863232" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Eleven pearls for cosmetic earlobe repair" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. Niamtu" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Dermatol Surg" "fecha" => "2002" "volumen" => "28" "paginaInicial" => "180" "paginaFinal" => "185" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11860433" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010700000009/v1_201611010039/S1578219016302153/v1_201611010039/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/15782190/0000010700000009/v1_201611010039/S1578219016302153/v1_201611010039/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016302153?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 13 | 9 | 22 |
| 2024 Octubre | 124 | 53 | 177 |
| 2024 Septiembre | 154 | 21 | 175 |
| 2024 Agosto | 210 | 65 | 275 |
| 2024 Julio | 220 | 40 | 260 |
| 2024 Junio | 146 | 52 | 198 |
| 2024 Mayo | 160 | 46 | 206 |
| 2024 Abril | 126 | 29 | 155 |
| 2024 Marzo | 115 | 32 | 147 |
| 2024 Febrero | 123 | 35 | 158 |
| 2024 Enero | 111 | 29 | 140 |
| 2023 Diciembre | 98 | 22 | 120 |
| 2023 Noviembre | 107 | 29 | 136 |
| 2023 Octubre | 97 | 25 | 122 |
| 2023 Septiembre | 86 | 31 | 117 |
| 2023 Agosto | 104 | 27 | 131 |
| 2023 Julio | 125 | 28 | 153 |
| 2023 Junio | 107 | 19 | 126 |
| 2023 Mayo | 104 | 23 | 127 |
| 2023 Abril | 107 | 33 | 140 |
| 2023 Marzo | 94 | 20 | 114 |
| 2023 Febrero | 74 | 23 | 97 |
| 2023 Enero | 77 | 23 | 100 |
| 2022 Diciembre | 49 | 44 | 93 |
| 2022 Noviembre | 51 | 26 | 77 |
| 2022 Octubre | 38 | 54 | 92 |
| 2022 Septiembre | 43 | 53 | 96 |
| 2022 Agosto | 54 | 57 | 111 |
| 2022 Julio | 55 | 33 | 88 |
| 2022 Junio | 32 | 21 | 53 |
| 2022 Mayo | 54 | 28 | 82 |
| 2022 Abril | 75 | 42 | 117 |
| 2022 Marzo | 92 | 45 | 137 |
| 2022 Febrero | 60 | 32 | 92 |
| 2022 Enero | 107 | 48 | 155 |
| 2021 Diciembre | 72 | 39 | 111 |
| 2021 Noviembre | 77 | 36 | 113 |
| 2021 Octubre | 95 | 80 | 175 |
| 2021 Septiembre | 71 | 36 | 107 |
| 2021 Agosto | 67 | 35 | 102 |
| 2021 Julio | 80 | 30 | 110 |
| 2021 Junio | 70 | 19 | 89 |
| 2021 Mayo | 67 | 37 | 104 |
| 2021 Abril | 75 | 92 | 167 |
| 2021 Marzo | 91 | 40 | 131 |
| 2021 Febrero | 52 | 31 | 83 |
| 2021 Enero | 32 | 15 | 47 |
| 2020 Diciembre | 16 | 18 | 34 |
| 2020 Noviembre | 30 | 18 | 48 |
| 2020 Octubre | 16 | 14 | 30 |
| 2020 Septiembre | 22 | 17 | 39 |
| 2020 Agosto | 23 | 22 | 45 |
| 2020 Julio | 30 | 17 | 47 |
| 2020 Junio | 34 | 32 | 66 |
| 2020 Mayo | 39 | 19 | 58 |
| 2020 Abril | 38 | 22 | 60 |
| 2020 Marzo | 36 | 8 | 44 |
| 2020 Febrero | 3 | 0 | 3 |
| 2020 Enero | 4 | 0 | 4 |
| 2019 Diciembre | 2 | 0 | 2 |
| 2019 Noviembre | 4 | 0 | 4 |
| 2019 Septiembre | 4 | 0 | 4 |
| 2019 Agosto | 4 | 0 | 4 |
| 2019 Julio | 4 | 0 | 4 |
| 2019 Junio | 3 | 0 | 3 |
| 2019 Mayo | 4 | 0 | 4 |
| 2019 Abril | 2 | 5 | 7 |
| 2019 Febrero | 2 | 0 | 2 |
| 2019 Enero | 3 | 0 | 3 |
| 2018 Noviembre | 3 | 0 | 3 |
| 2018 Octubre | 2 | 0 | 2 |
| 2018 Septiembre | 4 | 0 | 4 |
| 2018 Febrero | 27 | 4 | 31 |
| 2018 Enero | 41 | 16 | 57 |
| 2017 Diciembre | 49 | 15 | 64 |
| 2017 Noviembre | 26 | 7 | 33 |
| 2017 Octubre | 30 | 13 | 43 |
| 2017 Septiembre | 23 | 10 | 33 |
| 2017 Agosto | 28 | 12 | 40 |
| 2017 Julio | 45 | 15 | 60 |
| 2017 Junio | 33 | 18 | 51 |
| 2017 Mayo | 26 | 15 | 41 |
| 2017 Abril | 33 | 8 | 41 |
| 2017 Marzo | 21 | 22 | 43 |
| 2017 Febrero | 21 | 14 | 35 |
| 2017 Enero | 16 | 12 | 28 |
| 2016 Diciembre | 24 | 39 | 63 |
| 2016 Noviembre | 42 | 33 | 75 |
| 2016 Octubre | 4 | 13 | 17 |
Mostrar todo
