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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">Malignant umbilical skin lesions&#44; although infrequent&#44; usually require treatment that includes partial or total omphalectomy&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Given the esthetic importance of the umbilicus in the abdominal wall&#44; its reconstruction must be considered when planning surgical treatment&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Neoumbilicoplasty with an island pedicle flap can be performed in parallel with the omphalectomy&#44; and provides adequate esthetic results&#46; Although well described in dermatology for the reconstruction of central facial defects&#44; the use of this technique in this anatomical location has been described on only a few occasions&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;4</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Case Description</span><p id="par0015" class="elsevierStylePara elsevierViewall">An 82-year-old patient was evaluated for the growth of an asymmetric&#44; melanocytic umbilical lesion &#40;12&#8239;&#215;&#8239;6&#8239;mm&#41; with irregular borders and heterochromia&#44; and&#44; on dermoscopy&#44; an atypical pigment network&#44; grayish-blue dots&#44; and whitish areas &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; A partial biopsy was performed given the patient&#8217;s initial refusal to undergo surgery&#46; Histology revealed a predominantly in situ&#44; superficial spreading melanoma&#44; with extensive underlying regression and an invasive component of 1&#46;25&#8239;mm thick&#44; without ulceration or mitotic activity&#46; Wide excision with 2-cm margins was scheduled&#46; A tumor extension study&#44; including inguinal ultrasound and computerized axial tomography&#44; revealed no findings of relevance&#46; The patient refused to undergo a sentinel node biopsy&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Technique</span><p id="par0020" class="elsevierStylePara elsevierViewall">Under local anesthesia&#44; circular excision of the lesion is performed first &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A&#41;&#46; Next&#44; the size of the defect is reduced &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>B&#41; using a transient subcutaneous purse-string suture to calculate the size of the plasty &#40;x&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>C&#41;&#46; A spindle-shaped incision is designed with the major axis coinciding with the central point of the defect&#46; The length of the major axis is 3 times that of the defect &#40;3x&#41;&#44; while that of the minor axis corresponds to the length of the defect &#40;x&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>C&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> A tobacco pouch is created to facilitate subsequent resection of the lateral triangles and dissection of the island&#44; providing a subcutaneous pedicle long enough for transfer to the site of the defect &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>D&#41;&#46; The pedicle is fixed to the anterior rectus abdominis sheath using a transfixing U-stitch with a 3&#8722;0 polydioxanone suture&#44; lending the plasty the conical shape of the umbilicus&#46; The perimeter of the neo-umbilicus is sutured to the surrounding skin using loose stitches and the rest of the incision using a continuous running 4&#8722;0 suture &#40;polyamide 6&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>A&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The patient underwent antibiotic prophylaxis with a single dose of oral cephradine &#40;2&#8239;g&#41; 30&#8239;min before surgery and a compression bandage was applied for 48&#8239;hours&#44; followed by regular wound care&#46; The sutures were removed after 2 weeks &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>B&#41; and the patient was subsequently followed for 10 months with no complications &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>C&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">The techniques used to create a neo-umbilicus vary in design and technical complexity&#46; The main techniques used are plasties &#40;Borges technique&#44; V plasty&#44; C&#8211;V plasty&#44; unfolded cylinder plasty&#44; lunch-box-type plasty&#44; double V&#8211;Y plasty&#41;&#44; using rotation flaps&#44; triangular flaps&#44; reverse fan-shaped flaps&#44; island flaps&#44; M-shaped or inverted omega-shaped flaps&#44; and&#44; less frequently&#44; grafts&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Complications of these procedures include necrosis of the plasty&#44; infections&#44; hematoma formation&#44; suture dehiscence&#44; scar hypertrophy&#44; and umbilical flattening&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Plasty with an island pedicle flap offers a series of advantages including concordance of color&#44; texture&#44; and thickness of the tissues&#44; and avoids the compromise of other anatomical areas&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Plasty is performed with a generous vascular pedicle&#44; reducing the possibility of necrosis&#44; and involves little tension during closure&#44; therefore reducing the likelihood of dehiscence&#46; Moreover&#44; recovery time is relatively short&#46; Many of the more common techniques&#44; particularly those that leave no visible scars and have excellent esthetic results&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> use healthy abdominal skin&#44; and therefore need not contemplate the removal of a pre-existing umbilicus&#44; periumbilical lesions&#44; small surgical defects&#44; or excess skin resulting from a hernia when constructing the neo-umbilicus&#46; Plasty with an island pedicle flap allows concealment of moderate-sized defects such as that resulting from omphalectomy&#44; and can be performed as part of the same surgical procedure under local anesthesia&#44; ensuring a very adequate esthetic result&#46; For this anatomical location&#44; island plasty has been described using a horizontal orientation&#44; whereby the skin of the island is included in the incision closure and a central transfixing point&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> or a vertical orientation&#44; in which skin is taken from the area adjacent to the lesion and transformed into a conical shape&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> We feel that the vertical orientation promotes better closure with less tension and provides a preferable esthetic result&#46; Moreover&#44; the use of a transfixing U-stitch facilitates the conical transformation&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">In conclusion&#44; we propose island plasty with a vertical orientation and a central transfixing stich as a simple&#44; safe&#44; and esthetic technique for umbilical reconstruction after oncological surgery&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Funding</span><p id="par0045" class="elsevierStylePara elsevierViewall">This work did not receive any type of funding&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conflicts of Interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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Case and Research Letters
Neoumbiliconeoplasty With a Vertical Island Pedicle Flap
Neoumbilicoplastia mediante plastia en isla vertical
L. Vergara de la Campaa,
Autor para correspondencia
, A. Brincab, A. Pinhob, R. Vieirab
a Servicio de Dermatología, Complejo Hospitalario de Toledo, Toledo, Spain
b Servicio de Dermatología, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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        "titulo" => "Neoumbilicoplastia mediante plastia en isla vertical"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A&#44; Clinical image showing an asymmetric melanocytic lesion with irregular borders and heterochromia&#46; B&#44; Dermoscopic image showing a melanocytic lesion with an atypical pigment network&#44; blue-gray dots&#44; and whitish areas&#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">Malignant umbilical skin lesions&#44; although infrequent&#44; usually require treatment that includes partial or total omphalectomy&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Given the esthetic importance of the umbilicus in the abdominal wall&#44; its reconstruction must be considered when planning surgical treatment&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Neoumbilicoplasty with an island pedicle flap can be performed in parallel with the omphalectomy&#44; and provides adequate esthetic results&#46; Although well described in dermatology for the reconstruction of central facial defects&#44; the use of this technique in this anatomical location has been described on only a few occasions&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;4</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Case Description</span><p id="par0015" class="elsevierStylePara elsevierViewall">An 82-year-old patient was evaluated for the growth of an asymmetric&#44; melanocytic umbilical lesion &#40;12&#8239;&#215;&#8239;6&#8239;mm&#41; with irregular borders and heterochromia&#44; and&#44; on dermoscopy&#44; an atypical pigment network&#44; grayish-blue dots&#44; and whitish areas &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; A partial biopsy was performed given the patient&#8217;s initial refusal to undergo surgery&#46; Histology revealed a predominantly in situ&#44; superficial spreading melanoma&#44; with extensive underlying regression and an invasive component of 1&#46;25&#8239;mm thick&#44; without ulceration or mitotic activity&#46; Wide excision with 2-cm margins was scheduled&#46; A tumor extension study&#44; including inguinal ultrasound and computerized axial tomography&#44; revealed no findings of relevance&#46; The patient refused to undergo a sentinel node biopsy&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Technique</span><p id="par0020" class="elsevierStylePara elsevierViewall">Under local anesthesia&#44; circular excision of the lesion is performed first &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A&#41;&#46; Next&#44; the size of the defect is reduced &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>B&#41; using a transient subcutaneous purse-string suture to calculate the size of the plasty &#40;x&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>C&#41;&#46; A spindle-shaped incision is designed with the major axis coinciding with the central point of the defect&#46; The length of the major axis is 3 times that of the defect &#40;3x&#41;&#44; while that of the minor axis corresponds to the length of the defect &#40;x&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>C&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> A tobacco pouch is created to facilitate subsequent resection of the lateral triangles and dissection of the island&#44; providing a subcutaneous pedicle long enough for transfer to the site of the defect &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>D&#41;&#46; The pedicle is fixed to the anterior rectus abdominis sheath using a transfixing U-stitch with a 3&#8722;0 polydioxanone suture&#44; lending the plasty the conical shape of the umbilicus&#46; The perimeter of the neo-umbilicus is sutured to the surrounding skin using loose stitches and the rest of the incision using a continuous running 4&#8722;0 suture &#40;polyamide 6&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>A&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The patient underwent antibiotic prophylaxis with a single dose of oral cephradine &#40;2&#8239;g&#41; 30&#8239;min before surgery and a compression bandage was applied for 48&#8239;hours&#44; followed by regular wound care&#46; The sutures were removed after 2 weeks &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>B&#41; and the patient was subsequently followed for 10 months with no complications &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>C&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">The techniques used to create a neo-umbilicus vary in design and technical complexity&#46; The main techniques used are plasties &#40;Borges technique&#44; V plasty&#44; C&#8211;V plasty&#44; unfolded cylinder plasty&#44; lunch-box-type plasty&#44; double V&#8211;Y plasty&#41;&#44; using rotation flaps&#44; triangular flaps&#44; reverse fan-shaped flaps&#44; island flaps&#44; M-shaped or inverted omega-shaped flaps&#44; and&#44; less frequently&#44; grafts&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Complications of these procedures include necrosis of the plasty&#44; infections&#44; hematoma formation&#44; suture dehiscence&#44; scar hypertrophy&#44; and umbilical flattening&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Plasty with an island pedicle flap offers a series of advantages including concordance of color&#44; texture&#44; and thickness of the tissues&#44; and avoids the compromise of other anatomical areas&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Plasty is performed with a generous vascular pedicle&#44; reducing the possibility of necrosis&#44; and involves little tension during closure&#44; therefore reducing the likelihood of dehiscence&#46; Moreover&#44; recovery time is relatively short&#46; Many of the more common techniques&#44; particularly those that leave no visible scars and have excellent esthetic results&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> use healthy abdominal skin&#44; and therefore need not contemplate the removal of a pre-existing umbilicus&#44; periumbilical lesions&#44; small surgical defects&#44; or excess skin resulting from a hernia when constructing the neo-umbilicus&#46; Plasty with an island pedicle flap allows concealment of moderate-sized defects such as that resulting from omphalectomy&#44; and can be performed as part of the same surgical procedure under local anesthesia&#44; ensuring a very adequate esthetic result&#46; For this anatomical location&#44; island plasty has been described using a horizontal orientation&#44; whereby the skin of the island is included in the incision closure and a central transfixing point&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> or a vertical orientation&#44; in which skin is taken from the area adjacent to the lesion and transformed into a conical shape&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> We feel that the vertical orientation promotes better closure with less tension and provides a preferable esthetic result&#46; Moreover&#44; the use of a transfixing U-stitch facilitates the conical transformation&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">In conclusion&#44; we propose island plasty with a vertical orientation and a central transfixing stich as a simple&#44; safe&#44; and esthetic technique for umbilical reconstruction after oncological surgery&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Funding</span><p id="par0045" class="elsevierStylePara elsevierViewall">This work did not receive any type of funding&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conflicts of Interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A&#44; Wide excision of the lesion with 2-cm margins&#46; B&#44; Surgical defect &#40;40&#8239;&#215;&#8239;30&#8239;mm&#41;&#46; C&#44; Planning of reconstruction using an island pedicle flap&#46; The minor axis of the spindle-shaped incision is calculated to ensure a transitory tobacco-pouch closure &#40;x&#41;&#46; The major axis is 3 times the length of the minor axis &#40;3x&#41; and runs along the midline of the defect &#40;gray dashed line&#41;&#46; D&#44; The tobacco pouch is released&#44; and the lateral triangles are removed&#44; leaving a circular skin island that is dissected together with an adipose pedicle that enables its movement to the desired position&#46;</p>"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The island is moved to the desired position and fixed to the anterior sheath of the rectus abdominis muscle with a transfixing U-stitch to give it a conical shape&#46; The skin surrounding the neo-umbilicus is sutured with loose stitches and the remainder with a continuous running suture&#46; A&#44; Immediate postoperative result&#46; B&#44; After suture removal&#44; 14 days later&#46; C&#44; Ten months after the surgical intervention&#46;</p>"
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                      "titulo" => "Reconstruction of a natural-appearing umbilicus using an island flap&#58; Case report"
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                            0 => "N&#46; Kakudo"
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                            2 => "S&#46; Fujimori"
                            3 => "A&#46; Shimotsuma"
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                            4 => "H&#46;P&#46;J&#46;D&#46; Stevens"
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Información del artículo
ISSN: 15782190
Idioma original: Inglés
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