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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A&#44; Design and cutting of titanium mesh according to the size of the final defect&#46; B&#44; Incision parallel to the skin in the subcutaneous cell tissue in healthy skin surrounding the defect&#44; forming a pocket to subsequently hold the titanium mesh in place&#46; C&#44; Incision of melolabial flap&#46; D&#44; Anchoring the titanium mesh with absorbable 4&#47;0 suture&#46; E&#44; Start of the melolabial flap suture folded over the titanium mesh by its distal end &#40;forming the internal face of the nasal wall&#41;&#46; F&#44; External suture of the flap with 4&#47;0 silk thread&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Reconstruction of a full-thickness nasal alar defect may be complex because of the need to repair all involved structures &#40;nasal mucosa&#44; cartilage&#44; and skin&#41;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a> and preserve function while aiming for a good esthetic outcome&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The endonasal mucosa can be repaired by using inverted or folded flaps&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The melolabial region is the most common donor site although septal mucoperichondrial flaps can also be used&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Providing structural support is usually the most complicated aspect of the technique&#46; Alternative techniques include the use of bone or autologous cartilage &#40;from the septal&#44; atrial&#44; or costal region&#41;&#44; or alloplastic material&#44; using biocompatible materials such as titanium<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;4</span></a> or polyethylene&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> With biocompatible materials&#44; morbidity at the donor site is avoided&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and the risk of necrosis is decreased given that neovascularization is not required&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a> However&#44; unlike autologous tissue&#44; prosthetic material can be extruded&#44; and there is a greater risk of infection given that it is a foreign body&#59; the material may also interfere in future imaging studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> Nevertheless&#44; in the case of titanium mesh&#44; integration of the prosthetic material with the surrounding tissue has been reported&#44;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;4</span></a> thus minimizing the risk of extrusion if the alloplastic material is adequately covered&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Finally&#44; skin reconstruction is usually performed with free or pedicled flaps usually taken from the nasal&#44; melolabial&#44; or frontal region&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In a surgical video&#44; we present the reconstruction of a full-thickness alar nasal defect with titanium mesh after Mohs surgery for basal cell carcinoma &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; &#40;video in supplementary material&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Description of the Technique</span><p id="par0030" class="elsevierStylePara elsevierViewall">To reconstruct the full-thickness defect of the left nasal ala &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#44; a melolabial flap was folded over a 2-mm thick titanium mesh &#40;Synthes-Statec&#44; Medican FA&#44; Madrid&#41; as the supporting structure&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Under local anesthetic&#44; the procedure began by freshening the borders of the defect following Mohs surgery to remove a basal cell carcinoma&#46; The titanium mesh was designed&#44; cut&#44; and molded to the final size of the defect &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A&#41;&#46; To guarantee that the mesh was suitably anchored&#44; an incision of several millimeters was made into the perilesional skin to form a pocket &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>B&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Then&#44; incision of the melolabial flap &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>C&#41; &#40;with the same width as the defect&#41; and dissection of the subcutaneous plane were performed&#46; Once finished&#44; mobility and final positioning were checked&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The titanium mesh was introduced into the incisions made at the edges of the defect and it was held in place with an absorbable 4&#47;0 braided suture &#40;Vicryl&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>D&#41;&#46; Before starting to fold the flap over the titanium mesh and suturing&#44; careful hemostasis was performed and the most distal part of the flap was narrowed so that it would fit as closely as possible the endonasal mucosa&#46; Once folded&#44; the internal face of the distal end of the flat was sutured to the titanium mesh and to the healthy surrounding skin&#44; starting from the tip&#44; using a strand of absorbable 4&#47;0 braided suture &#40;Vicryl&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>E&#41;&#44; thus reconstructing the internal face of the alar wall&#46; Finally&#44; the rest of the flap was sutured &#40;to contour the external face of the ala&#41; with 4&#47;0 silk thread &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>F&#41; and the secondary defect was closed directly from the donor area with a continuous blocked suture using 4&#47;0 silk thread &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>A-C&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Indications</span><p id="par0050" class="elsevierStylePara elsevierViewall">Full-thickness skin defects at the nasal site&#44; in which the use of other&#44; simpler&#44; reconstructive techniques will likely lead to collapse of the nasal fossa or a poor esthetic outcome or&#44; in view of the size&#44; the use of autologous cartilage as support material may have a high risk of necrosis or distortion of the donor region&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Contraindications</span><p id="par0055" class="elsevierStylePara elsevierViewall">There is no absolute contraindication&#46; Relative contraindications include coagulation disorders and risk factors for skin ischemia &#40;smoking habit&#44; prior radiotherapy&#44; diabetic foot&#44; etc&#46;&#41; that would compromise the viability of the flap&#44; and the indication of adjuvant radiotherapy&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Complications</span><p id="par1060" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0060" class="elsevierStylePara elsevierViewall">Infection</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0065" class="elsevierStylePara elsevierViewall">Hemorrhage&#44; hematoma&#44; and skin necrosis</p></li><li class="elsevierStyleListItem" id="lsti1005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0070" class="elsevierStylePara elsevierViewall">Extrusion of prosthetic material</p></li><li class="elsevierStyleListItem" id="lsti2005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0075" class="elsevierStylePara elsevierViewall">Temporary or permanent sensory alterations due to lesions to nerve structures</p></li><li class="elsevierStyleListItem" id="lsti3005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0080" class="elsevierStylePara elsevierViewall">Increased risk of radionecrosis</p></li><li class="elsevierStyleListItem" id="lsti4005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0085" class="elsevierStylePara elsevierViewall">Excessive thickness of the nasal ala that could lead to a poor esthetic outcome and even obstruction of the nasal fossa</p></li></ul></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusion</span><p id="par0090" class="elsevierStylePara elsevierViewall">Nasal reconstruction with a titanium mesh is a good reconstructive option in large full-thickness&#44; nasal defects in which there is a risk of collapse of the nasal fossa and where the use of other flaps is not a viable alternative and the use of cartilage grafts could be compromising&#46; The intervention is laborious and presents a certain technical complexity&#44; but as shown&#44; good functional and esthetic outcomes can be achieved &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>D-F&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of Interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Fern&#225;ndez Canga P&#44; Casti&#241;eiras Gonz&#225;lez J&#44; Rodr&#237;guez Prieto MA&#46; Reconstrucci&#243;n de un defecto de espesor total en ala nasal con malla de titanio&#46; Actas Dermosifiliogr&#46; 2020&#59;111&#58;265&#8211;268&#46;</p>"
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