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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The pinna is a complex structure with contour lines that should be conserved during reconstruction&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> One of these lines is formed by the helix&#44; which gives the distinctive shape to the ear&#46; This is also the site of half the malignant tumors that arise in the pinna&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Techniques for reconstruction are varied and include direct closure&#44; grafts&#44; and skin or chondrocutaneous advancement flaps&#44; where the choice of which to use is guided by the particular needs of each case&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> However&#44; large upper-pole defects remain a challenge for reconstructive surgery&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">An 85-year-old woman from a remote region of Colombia &#40;Orinoco region&#41;&#44; presented with invasive basal cell carcinoma measuring 15&#8239;&#215;&#8239;15&#8239;mm on the upper part of the right helix&#46; The tumor was treated by transfixing resection with lateral margins of 8&#8239;mm&#46; The postsurgical defect measured 35&#8239;mm in diameter and covered more than one-third of the length of the helix&#46; Use of several flaps in different procedures was ruled out given the patient&#8217;s difficulty to travel to our hospital&#46; Instead&#44; the Antia-Buch technique was chosen using 2 flaps&#44; an upper one and a lower one&#46; To construct the flaps&#44; an incision was made in the skin anterior to the ear and the cartilage without cutting posterior skin&#46; Dissection was performed superficially to the posterior perichondrium&#44; such that the flaps only had cartilage in their distal portion&#46; A wedge was cut in the antihelix to enable the flaps to be drawn together&#46; The flaps were advanced and sutured in layers with Vicryl&#174; and Prolene&#174; 5&#47;0 stitches&#46; A V-Y closure was performed on the upper secondary defect &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The outcome 1 week later was a functional pinna with no cup ear deformity &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; The patient had an area of superficial necrosis of less than 1&#8239;cm that fully re-epithelialized&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Reconstruction of the pinna should seek to preserve its auxiliary function in the auditive process and as a support for glasses&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The main esthetic objectives of reconstruction include retaining symmetry&#44; preserving a smooth helix with its characteristic form&#44; and preserving skin color and texture&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">There are different reconstructive techniques available and the choice of which to use depends on the site and size of the defects&#46; In the upper helix&#44; defects with no cartilage involvement can be resolved with skin grafts or local skin flaps&#46; Defects of the helix with loss of cartilage may impact the shape of the pinna and so re-epithelization by second intent&#44; grafts&#44; and local skin flaps are insufficient&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Helical defects of less than 10&#8239;mm can be resolved by primary closure or compound grafts&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Larger defects need chondrocutaneous advancement flaps&#44; such as the Antia-Buch flap&#44; and&#44; if the defects are greater than 20&#8239;mm&#44; retroauricular island flaps or temporoparietal fascial flaps with cartilage graft can be used&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Chondrocutaneous advancement flap of the helix is a simple technique described in 1967 by Antia and Buch to reconstruct the transfixing defects of the helix in a single surgical procedure&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Depending on the size and site of the defect&#44; 1 or 2 simultaneous flaps may be required&#46; The incisions should be made parallel to the helix in the anterior face of the pinna&#44; including the cartilage&#44; but without making an incision in the posterior skin as the flaps are based on branches of the posterior auricular artery&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The posterior face of the ear is then dissected to separate the skin from the cartilage&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> This maneuver frees the flaps and allows them to be advanced&#46; Before suturing the flaps&#44; it is necessary to assess whether they are long enough to surround the pinna&#46; If not&#44; cartilage should be cut away from the concha or the antihelix&#46; The secondary defect of the upper flap can be closed with the V-Y technique&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> whereas the inferior flap may require a Burrow triangle to compensate for any redundant tissue &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The Antia-Buch technique plays an important role in reconstruction of the upper pole of the ear&#59; however&#44; more complex techniques are preferred for defects measuring more than 20&#8239;mm&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> One of the concerns with the Antia-Buch flap for large defects is cup ear deformity&#46; However&#44; modifications to this technique&#44; such as half-moon or wedge cuts of the antihelix and concha can avoid this problem&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;7&#44;8</span></a> A main advantage of this technique is that it only requires one operation&#46; This is desirable in patients of advanced age&#44; those with comorbidities&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> or those with difficulties traveling to hospital&#59; 3 conditions often seen in our everyday practice&#46; With this case&#44; we would like to highlight the simplicity and usefulness of this technique for reconstruction of large defects of the pinna in the upper pole&#44; particularly when only one operation is desirable&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0035" 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
Antia-Buch Flap for a Large Upper-Pole Defect of the Ear
Colgajo de Antia-Buch para un defecto amplio del polo superior de la oreja
J.C. Barrera Gamboaa,
Autor para correspondencia
jcbgmd@hotmail.com

Corresponding author.
, Á.E. Acosta Madiedo de Hartb
a Instituto Nacional de Cancerología, Bogotá D.C., Colombia
b Instituto Nacional de Cancerología, programa curricular de dermatología, Universidad Nacional de Colombia, Bogotá D.C., Colombia
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    "titulo" => "Antia-Buch Flap for a Large Upper-Pole Defect of the Ear"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The pinna is a complex structure with contour lines that should be conserved during reconstruction&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> One of these lines is formed by the helix&#44; which gives the distinctive shape to the ear&#46; This is also the site of half the malignant tumors that arise in the pinna&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Techniques for reconstruction are varied and include direct closure&#44; grafts&#44; and skin or chondrocutaneous advancement flaps&#44; where the choice of which to use is guided by the particular needs of each case&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> However&#44; large upper-pole defects remain a challenge for reconstructive surgery&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">An 85-year-old woman from a remote region of Colombia &#40;Orinoco region&#41;&#44; presented with invasive basal cell carcinoma measuring 15&#8239;&#215;&#8239;15&#8239;mm on the upper part of the right helix&#46; The tumor was treated by transfixing resection with lateral margins of 8&#8239;mm&#46; The postsurgical defect measured 35&#8239;mm in diameter and covered more than one-third of the length of the helix&#46; Use of several flaps in different procedures was ruled out given the patient&#8217;s difficulty to travel to our hospital&#46; Instead&#44; the Antia-Buch technique was chosen using 2 flaps&#44; an upper one and a lower one&#46; To construct the flaps&#44; an incision was made in the skin anterior to the ear and the cartilage without cutting posterior skin&#46; Dissection was performed superficially to the posterior perichondrium&#44; such that the flaps only had cartilage in their distal portion&#46; A wedge was cut in the antihelix to enable the flaps to be drawn together&#46; The flaps were advanced and sutured in layers with Vicryl&#174; and Prolene&#174; 5&#47;0 stitches&#46; A V-Y closure was performed on the upper secondary defect &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The outcome 1 week later was a functional pinna with no cup ear deformity &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; The patient had an area of superficial necrosis of less than 1&#8239;cm that fully re-epithelialized&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Reconstruction of the pinna should seek to preserve its auxiliary function in the auditive process and as a support for glasses&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The main esthetic objectives of reconstruction include retaining symmetry&#44; preserving a smooth helix with its characteristic form&#44; and preserving skin color and texture&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">There are different reconstructive techniques available and the choice of which to use depends on the site and size of the defects&#46; In the upper helix&#44; defects with no cartilage involvement can be resolved with skin grafts or local skin flaps&#46; Defects of the helix with loss of cartilage may impact the shape of the pinna and so re-epithelization by second intent&#44; grafts&#44; and local skin flaps are insufficient&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Helical defects of less than 10&#8239;mm can be resolved by primary closure or compound grafts&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Larger defects need chondrocutaneous advancement flaps&#44; such as the Antia-Buch flap&#44; and&#44; if the defects are greater than 20&#8239;mm&#44; retroauricular island flaps or temporoparietal fascial flaps with cartilage graft can be used&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Chondrocutaneous advancement flap of the helix is a simple technique described in 1967 by Antia and Buch to reconstruct the transfixing defects of the helix in a single surgical procedure&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Depending on the size and site of the defect&#44; 1 or 2 simultaneous flaps may be required&#46; The incisions should be made parallel to the helix in the anterior face of the pinna&#44; including the cartilage&#44; but without making an incision in the posterior skin as the flaps are based on branches of the posterior auricular artery&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The posterior face of the ear is then dissected to separate the skin from the cartilage&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> This maneuver frees the flaps and allows them to be advanced&#46; Before suturing the flaps&#44; it is necessary to assess whether they are long enough to surround the pinna&#46; If not&#44; cartilage should be cut away from the concha or the antihelix&#46; The secondary defect of the upper flap can be closed with the V-Y technique&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> whereas the inferior flap may require a Burrow triangle to compensate for any redundant tissue &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The Antia-Buch technique plays an important role in reconstruction of the upper pole of the ear&#59; however&#44; more complex techniques are preferred for defects measuring more than 20&#8239;mm&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> One of the concerns with the Antia-Buch flap for large defects is cup ear deformity&#46; However&#44; modifications to this technique&#44; such as half-moon or wedge cuts of the antihelix and concha can avoid this problem&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;7&#44;8</span></a> A main advantage of this technique is that it only requires one operation&#46; This is desirable in patients of advanced age&#44; those with comorbidities&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> or those with difficulties traveling to hospital&#59; 3 conditions often seen in our everyday practice&#46; With this case&#44; we would like to highlight the simplicity and usefulness of this technique for reconstruction of large defects of the pinna in the upper pole&#44; particularly when only one operation is desirable&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0035" 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; Barrera Gamboa JC&#44; Acosta Madiedo de Hart AE&#46; Colgajo de Antia-Buch para un defecto amplio del polo superior de la oreja&#46; Actas Dermosifiliogr&#46; 2021&#59;112&#58;558&#8211;559&#46;</p>"
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ISSN: 15782190
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