Estadísticas

 array:24 [
  "pii" => "S1578219021002389"
  "issn" => "15782190"
  "doi" => "10.1016/j.adengl.2021.07.026"
  "estado" => "S300"
  "fechaPublicacion" => "2021-10-01"
  "aid" => "2659"
  "copyrightAnyo" => "2021"
  "documento" => "article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "fla"
  "cita" => "Actas Dermosifiliogr. 2021;112:794-7"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:1 [
    "total" => 0
  ]
  "Traduccion" => array:1 [
    "es" => array:20 [
      "pii" => "S0001731021001770"
      "issn" => "00017310"
      "doi" => "10.1016/j.ad.2021.04.007"
      "estado" => "S300"
      "fechaPublicacion" => "2021-10-01"
      "aid" => "2659"
      "copyright" => "AEDV"
      "documento" => "article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "fla"
      "cita" => "Actas Dermosifiliogr. 2021;112:794-7"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:1 [
        "total" => 0
      ]
      "es" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">ORIGINAL</span>"
        "titulo" => "Seguridad en los procedimientos dermatol&#243;gicos&#58; oclusi&#243;n vascular por materiales de relleno"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "794"
            "paginaFinal" => "797"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Safety in Dermatologic Procedures&#58; Vascular Occlusion by Filling Materials"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0015"
            "etiqueta" => "Figura 3"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr3.jpeg"
                "Alto" => 1169
                "Ancho" => 3167
                "Tamanyo" => 307638
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Protocolo de compromiso visual&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "E&#46; Vargas-Laguna, J&#46; Garc&#237;a-Gav&#237;n, E&#46; B&#225;rcena-Ruiz"
            "autores" => array:3 [
              0 => array:2 [
                "nombre" => "E&#46;"
                "apellidos" => "Vargas-Laguna"
              ]
              1 => array:2 [
                "nombre" => "J&#46;"
                "apellidos" => "Garc&#237;a-Gav&#237;n"
              ]
              2 => array:2 [
                "nombre" => "E&#46;"
                "apellidos" => "B&#225;rcena-Ruiz"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S1578219021002389"
          "doi" => "10.1016/j.adengl.2021.07.026"
          "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/S1578219021002389?idApp=UINPBA000044"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731021001770?idApp=UINPBA000044"
      "url" => "/00017310/0000011200000009/v1_202110020514/S0001731021001770/v1_202110020514/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S1578219021002134"
    "issn" => "15782190"
    "doi" => "10.1016/j.adengl.2021.07.013"
    "estado" => "S300"
    "fechaPublicacion" => "2021-10-01"
    "aid" => "2670"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Actas Dermosifiliogr. 2021;112:798-805"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Candidate allergens for inclusion in the Spanish Standard Series based on data from the Spanish Contact Dermatitis Registry"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "798"
          "paginaFinal" => "805"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Al&#233;rgenos candidatos para ser incluidos en la serie est&#225;ndar espa&#241;ola a partir de los datos del Registro Espa&#241;ol de Dermatitis de Contacto"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "C&#46;P&#46; Hern&#225;ndez-Fern&#225;ndez, P&#46; Mercader-Garc&#237;a, J&#46;F&#46; Silvestre Salvador, J&#46; S&#225;nchez P&#233;rez, V&#46; Fern&#225;ndez Redondo, F&#46;J&#46; Miquel Miquel, F&#46;J&#46; Ortiz de Frutos, M&#46;E&#46; Gatica Ortega, V&#46; Mora Fern&#225;ndez, A&#46;M&#46; Gim&#233;nez Arnau, V&#46; Zaragoza Ninet, R&#46; Gonz&#225;lez P&#233;rez, T&#46; Sanz S&#225;nchez, M&#46;A&#46; Pastor Nieto, E&#46; Serra Baldrich, S&#46; C&#243;rdoba Guijarro, F&#46; Heras Mendaza, I&#46; Ruiz Gonz&#225;lez, M&#46; Rodr&#237;guez Serna, M&#46; Hervella Garc&#233;s, M&#46;A&#46; Gallego Descalzo, I&#46; Garc&#237;a Doval, L&#46; Borrego Hernando"
          "autores" => array:23 [
            0 => array:2 [
              "nombre" => "C&#46;P&#46;"
              "apellidos" => "Hern&#225;ndez-Fern&#225;ndez"
            ]
            1 => array:2 [
              "nombre" => "P&#46;"
              "apellidos" => "Mercader-Garc&#237;a"
            ]
            2 => array:2 [
              "nombre" => "J&#46;F&#46;"
              "apellidos" => "Silvestre Salvador"
            ]
            3 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "S&#225;nchez P&#233;rez"
            ]
            4 => array:2 [
              "nombre" => "V&#46;"
              "apellidos" => "Fern&#225;ndez Redondo"
            ]
            5 => array:2 [
              "nombre" => "F&#46;J&#46;"
              "apellidos" => "Miquel Miquel"
            ]
            6 => array:2 [
              "nombre" => "F&#46;J&#46;"
              "apellidos" => "Ortiz de Frutos"
            ]
            7 => array:2 [
              "nombre" => "M&#46;E&#46;"
              "apellidos" => "Gatica Ortega"
            ]
            8 => array:2 [
              "nombre" => "V&#46;"
              "apellidos" => "Mora Fern&#225;ndez"
            ]
            9 => array:2 [
              "nombre" => "A&#46;M&#46;"
              "apellidos" => "Gim&#233;nez Arnau"
            ]
            10 => array:2 [
              "nombre" => "V&#46;"
              "apellidos" => "Zaragoza Ninet"
            ]
            11 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "Gonz&#225;lez P&#233;rez"
            ]
            12 => array:2 [
              "nombre" => "T&#46;"
              "apellidos" => "Sanz S&#225;nchez"
            ]
            13 => array:2 [
              "nombre" => "M&#46;A&#46;"
              "apellidos" => "Pastor Nieto"
            ]
            14 => array:2 [
              "nombre" => "E&#46;"
              "apellidos" => "Serra Baldrich"
            ]
            15 => array:2 [
              "nombre" => "S&#46;"
              "apellidos" => "C&#243;rdoba Guijarro"
            ]
            16 => array:2 [
              "nombre" => "F&#46;"
              "apellidos" => "Heras Mendaza"
            ]
            17 => array:2 [
              "nombre" => "I&#46;"
              "apellidos" => "Ruiz Gonz&#225;lez"
            ]
            18 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Rodr&#237;guez Serna"
            ]
            19 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Hervella Garc&#233;s"
            ]
            20 => array:2 [
              "nombre" => "M&#46;A&#46;"
              "apellidos" => "Gallego Descalzo"
            ]
            21 => array:2 [
              "nombre" => "I&#46;"
              "apellidos" => "Garc&#237;a Doval"
            ]
            22 => array:2 [
              "nombre" => "L&#46;"
              "apellidos" => "Borrego Hernando"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0001731021001927"
        "doi" => "10.1016/j.ad.2021.05.005"
        "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/S0001731021001927?idApp=UINPBA000044"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219021002134?idApp=UINPBA000044"
    "url" => "/15782190/0000011200000009/v1_202110091021/S1578219021002134/v1_202110091021/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S1578219021002122"
    "issn" => "15782190"
    "doi" => "10.1016/j.adengl.2021.07.012"
    "estado" => "S300"
    "fechaPublicacion" => "2021-10-01"
    "aid" => "2658"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Actas Dermosifiliogr. 2021;112:781-93"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Epidermolysis Bullosa in Spain&#58; Observational Study of a Cohort of Patients Treated in a National Referral Center"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "781"
          "paginaFinal" => "793"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Epiderm&#243;lisis bullosa en Espa&#241;a&#58; Estudio observacional de una cohorte de pacientes atendidos en un centro de referencia nacional"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig0010"
          "etiqueta" => "Figure 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 1643
              "Ancho" => 1500
              "Tamanyo" => 395385
            ]
          ]
          "detalles" => array:1 [
            0 => array:3 [
              "identificador" => "at0010"
              "detalle" => "Figure "
              "rol" => "short"
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Extracutaneous complications in patients with RDEB&#46; A&#44; Patient with a local skin superinfection&#46; B&#44; Pseudosyndactyly on feet&#46; C&#44; SCC on the knee of a patient with RDEB&#46; D&#44; Fluorescein-positive ulcer on the corneal epithelium&#46; RDEB refers to recessive dystrophic epidermolysis bullosa&#59; SCC&#44; squamous cell carcinoma&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "R&#46; Maseda Pedrero, L&#46; Quintana Castanedo, I&#46; P&#233;rez Conde, M&#46; Jim&#233;nez Gonz&#225;lez, M&#46;J&#46; Esc&#225;mez Toledano, R&#46; de Lucas Laguna"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "Maseda Pedrero"
            ]
            1 => array:2 [
              "nombre" => "L&#46;"
              "apellidos" => "Quintana Castanedo"
            ]
            2 => array:2 [
              "nombre" => "I&#46;"
              "apellidos" => "P&#233;rez Conde"
            ]
            3 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Jim&#233;nez Gonz&#225;lez"
            ]
            4 => array:2 [
              "nombre" => "M&#46;J&#46;"
              "apellidos" => "Esc&#225;mez Toledano"
            ]
            5 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "de Lucas Laguna"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0001731021001769"
        "doi" => "10.1016/j.ad.2021.04.006"
        "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/S0001731021001769?idApp=UINPBA000044"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219021002122?idApp=UINPBA000044"
    "url" => "/15782190/0000011200000009/v1_202110091021/S1578219021002122/v1_202110091021/en/main.assets"
  ]
  "en" => array:21 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
    "titulo" => "Safety in Dermatologic Procedures&#58; Vascular Occlusion by Filling Materials"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "794"
        "paginaFinal" => "797"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "E&#46; Vargas-Laguna, J&#46; Garc&#237;a-Gav&#237;n, E&#46; B&#225;rcena-Ruiz"
        "autores" => array:3 [
          0 => array:4 [
            "nombre" => "E&#46;"
            "apellidos" => "Vargas-Laguna"
            "email" => array:1 [
              0 => "elenavargas@dermaniac.com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "&#42;"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "J&#46;"
            "apellidos" => "Garc&#237;a-Gav&#237;n"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "E&#46;"
            "apellidos" => "B&#225;rcena-Ruiz"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:3 [
          0 => array:3 [
            "entidad" => "Servicio de Dermatolog&#237;a&#44; Hospital Severo Ochoa&#44; Madrid&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Dermatolog&#237;a&#44; Cl&#237;nica Gav&#237;n Dermat&#243;logos&#44; Vigo&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Servicio de Radiolog&#237;a Intervencionista&#44; Madrid&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Seguridad en los procedimientos dermatol&#243;gicos&#58; oclusi&#243;n vascular por materiales de relleno"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 2211
            "Ancho" => 2507
            "Tamanyo" => 436321
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Facial arteries&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Complications due to vascular occlusion when using injectable materials are dermatologic emergencies that require immediate medical attention to minimize the risk of sequelae&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">These ischemic processes can cause localized skin necrosis or Nicolau syndrome&#44; loss of vision&#44; and even stroke&#46; They are due to the obstruction of flow by intra-arterial injection and by external compression of the vessel by the filler&#46; When intra-arterial injection generates retrograde flow&#44; it can obstruct arteries such as the central artery of the retina&#46; Injections in any area of the face can be dangerous&#44; but the areas of greatest risk of causing blindness are the nose&#44; glabella&#44; forehead&#44; and&#44; less frequently&#44; the eyebrows&#44; temple&#44; and nasolabial fold<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">It is important that the informed consent for these procedures indicate the risk of skin necrosis and visual impairment&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Prevention</span><p id="par0020" class="elsevierStylePara elsevierViewall">Preventing these complications requires an understanding of the anatomy &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; and an understanding of the planes of injection and mastery of the techniques involved&#46; Retrograde techniques and the use of cannulas are preferred<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46; Injection should be performed slowly without exerting pressure to prevent retrograde flow when injecting at an intravascular site&#46; It is advisable to move the needle and cannula constantly while injecting&#46; The cannula should be 25-gauge or thicker and&#44; if needles are used&#44; they should be fine and be used with small-diameter syringes<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46; When performing supraperiosteal bolus injections with a needle&#44; aspiration is recommended&#44; although the sensitivity of the aspiration is only 60&#37;&#44; and aspiration time will vary depending on the coherence and consistence of the filler&#46; During aspiration&#44; it is important to fix the position of the needle<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#44; maintain good negative pressure&#44; and withdraw and release the plunger slowly&#46; Nevertheless&#44; neither negative aspiration nor the use of cannulas can guarantee avoiding a blood vessel&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Other measures that may help include directing the needle perpendicular to the main axial vessels&#44; pressing with the nondominant hand on the areas where retrograde flow is undesirable&#44; and pinching the injection site to generate a little ischemia&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">When a complication does occur&#44; it is important to recognize the initial symptoms of vascular involvement&#46; Occlusion of a facial artery will cause pain and whitening of the skin&#44; and this may occur at a distance from the injection site&#46; Pain may not be present if the filler is used with an anaesthetic&#46; Livedo reticularis will develop after a few minutes&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">If loss of vision occurs&#44; it may be accompanied by eye pain and periocular changes such as ptosis&#44; ophthalmoplegia&#44; strabismus&#44; and pupil dilation&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Treatment</span><p id="par0040" class="elsevierStylePara elsevierViewall">Although these events are rare&#44; it is very important to have a clear and simple action protocol&#46; All the necessary material should be to hand at all times and personnel should be trained to be able to remain calm and help with treating the patient and organizing the consulting room&#46; As the adverse effect is likely to occur outside a hospital setting&#44; every effort must be made to inform the patient and their family and to instate the treatments indicated in most current protocols<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#8211;9</span></a>&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Required material&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8211;</span><p id="par0050" class="elsevierStylePara elsevierViewall">Lyophilized hyaluronidase in vials&#46; 1&#44;500 UI&#46; It is advisable to have 3 vials plus a spare&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8211;</span><p id="par0055" class="elsevierStylePara elsevierViewall">Dilute lidocaine for local anesthesia&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8211;</span><p id="par0060" class="elsevierStylePara elsevierViewall">Acetylsalicylic acid &#40;500-mg tablets&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8211;</span><p id="par0065" class="elsevierStylePara elsevierViewall">Compresses&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8211;</span><p id="par0070" class="elsevierStylePara elsevierViewall">Injection material and cannulas&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8211;</span><p id="par0075" class="elsevierStylePara elsevierViewall">Drugs to treat hyaluronidase-associated anaphylaxis&#46;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">o</span><p id="par0080" class="elsevierStylePara elsevierViewall">Methylprednisolone&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">o</span><p id="par0085" class="elsevierStylePara elsevierViewall">Adrenaline&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">o</span><p id="par0090" class="elsevierStylePara elsevierViewall">Minimum respiratory support material&#46;</p></li></ul></p></li></ul></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Cutaneous Involvement</span><p id="par0095" class="elsevierStylePara elsevierViewall">We propose a three-step protocol &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#44; which can be summarized as <span class="elsevierStyleBold">notify</span>&#44; <span class="elsevierStyleBold">treat</span>&#44; and <span class="elsevierStyleBold">evaluate</span>&#46; If the filler used is hyaluronic&#44; pharmacological treatment is based on injecting hyaluronidase in the affected area&#46; Three separate injections an hour apart are recommended&#44; preferably using a cannula&#46; An acetylsalicylic acid tablet should be administered and warm compresses should be applied&#46; If the course is favorable&#44; the patient can be sent home with prescribed treatment and scheduled check-ups&#46; If the course is not good&#44; the option of a hospital assessment should be considered to manage pain and for follow-up&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Visual Involvement</span><p id="par0100" class="elsevierStylePara elsevierViewall">We propose a three-step protocol &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#44; which can be summarized as <span class="elsevierStyleBold">notify</span>&#44; <span class="elsevierStyleBold">prepare</span>&#44; and <span class="elsevierStyleBold">hospital</span>&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">Visual involvement is an emergency with a 90-minute window of opportunity and should be handled in a hospital&#46; Thus&#44; all efforts must be aimed at informing the patient and ensuring that they are transferred as quickly as possible&#46; Unfortunately&#44; hospital services vary greatly depending on the setting&#46; The ideal scenario is to have an ophthalmologist and an interventional radiologist&#46; The hospital pharmacy will probably not have the drug hyaluronidase and it should therefore be brought when accompanying the patient to the hospital&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Before the patient is transferred to the hospital&#44; a peribulbar injection of hyaluronidase may be given in the clinic and timolol 0&#46;5&#37; ophthalmic solution may be applied&#44; massaging the eye for 5&#160;minutes in 15-second cycles to reduce intraocular pressure and to attempt to move the embolism to a more distal artery&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Stroke protocol must be activated in the hospital&#46; The treatments described are anterior chamber paracentesis to reduce intraocular pressure&#44; retrobulbar injection of hyaluronidase and intravascular injection of hyaluronidase or urokinase<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#46; These techniques are highly specific and should be performed by specialist physicians who are familiar with them&#59; this means that&#44; even visiting a hospital cannot guarantee treatment within 90&#160;minutes of the event&#46; Any patient with vascular involvement must be admitted to hospital to undergo additional tests&#44; instate medical treatment&#44; and perform follow-up&#46; Magnetic resonance imaging is usually ordered to detect retrobulbar hematoma and&#47;or brain damage due to ischemia and treatment is instated with prostaglandin E1&#44; low-molecular-weight heparin&#44; pentoxifylline&#44; and&#44; if available&#44; hyperbaric oxygen&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conflicts of Interest</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:12 [
        0 => array:3 [
          "identificador" => "xres1585946"
          "titulo" => "Abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0005"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1427047"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres1585945"
          "titulo" => "Resumen"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0010"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1427046"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Prevention"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Treatment"
        ]
        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Cutaneous Involvement"
        ]
        8 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Visual Involvement"
        ]
        9 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Conflicts of Interest"
        ]
        10 => array:2 [
          "identificador" => "xack560497"
          "titulo" => "Acknowledgments"
        ]
        11 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2021-02-08"
    "fechaAceptado" => "2021-04-15"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1427047"
          "palabras" => array:5 [
            0 => "Dermal fillers"
            1 => "Hyaluronic acid"
            2 => "Ischemia"
            3 => "Hyaluronidase"
            4 => "Nicolau syndrome"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1427046"
          "palabras" => array:5 [
            0 => "Rellenos d&#233;rmicos"
            1 => "&#193;cido hialur&#243;nico"
            2 => "Isquemia"
            3 => "Hialuronidasa"
            4 => "S&#237;ndrome de Nicolau"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Ischemic events are the most serious complications of facial antiaging treatment with dermal fillers&#46; Ischemia can cause Nicolau syndrome&#44; blindness&#44; or even stroke&#46; This article discusses how to prevent ischemic complications and what steps to take should a dermatologic emergency develop&#46; A thorough understanding of facial anatomy is important&#46; Preferred procedural techniques involve the use of cannulas and retrograde injection&#46; When ischemia is detected in the skin&#44; hyaluronidase should be injected&#44; preferably through a cannula&#46; If ocular ischemia occurs&#44; the patient should be transferred to a hospital with stroke code activation&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Las complicaciones m&#225;s graves del tratamiento con los rellenos d&#233;rmicos para el rejuvenecimiento facial son las isqu&#233;micas&#44; que pueden provocar un s&#237;ndrome de Nicolau&#44; una ceguera o&#44; incluso&#44; un ictus&#46; Se describen las medidas preventivas que es conveniente aplicar cuando se realizan estos procedimientos y&#44; en caso de que aparezcan&#44; se proponen los pasos a seguir ante esta urgencia dermatol&#243;gica&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Es importante tener un amplio conocimiento de la anatom&#237;a facial&#46; Son preferibles el uso de c&#225;nulas y las t&#233;cnicas de infiltraci&#243;n retr&#243;gradas&#46; Cuando aparece un evento isqu&#233;mico cut&#225;neo&#44; usaremos hialuronidasa infiltrada preferiblemente con c&#225;nula&#46; Si el evento isqu&#233;mico ocurre a nivel ocular se trasladar&#225; al paciente a un medio hospitalario con c&#243;digo ictus&#46;</p></span>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Vargas-Laguna E&#44; Garc&#237;a-Gav&#237;n J&#44; B&#225;rcena-Ruiz E&#46; Seguridad en los procedimientos dermatol&#243;gicos&#58; oclusi&#243;n vascular por materiales de relleno&#46; Actas Dermosifiliogr&#46; 2021&#59;112&#58;794&#8211;797&#46;</p>"
      ]
    ]
    "multimedia" => array:3 [
      0 => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 2211
            "Ancho" => 2507
            "Tamanyo" => 436321
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Facial arteries&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1214
            "Ancho" => 3200
            "Tamanyo" => 421849
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0010"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Skin-involvement protocol&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1169
            "Ancho" => 3167
            "Tamanyo" => 307821
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0015"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Visual-involvement protocol&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Soft-tissue filler-associated blindness&#58; a systematic review of case reports and case series"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "V&#46; Chatrath"
                            1 => "P&#46;S&#46; Banerjee"
                            2 => "E&#46; Rahman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Plast Reconstr Surg Glob Open"
                        "fecha" => "2019"
                        "volumen" => "7"
                        "paginaInicial" => "e2173"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Complications and litigation associated with injectable facial fillers&#58; a cross-sectional study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46; Beauvais"
                            1 => "E&#46;M&#46; Ferneini"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.joms.2019.08.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Oral Maxillofac Surg"
                        "fecha" => "2020"
                        "volumen" => "78"
                        "paginaInicial" => "133"
                        "paginaFinal" => "140"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31493376"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Rates of vascular occlusion associated with using needles vs cannulas for filler injection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Alam"
                            1 => "R&#46; Kakar"
                            2 => "J&#46;S&#46; Dover"
                            3 => "V&#46; Harikumar"
                            4 => "B&#46;Y&#46; Kang"
                            5 => "H&#46;T&#46; Wan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jamadermatol.2020.5102"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA Dermatol"
                        "fecha" => "2021"
                        "volumen" => "157"
                        "paginaInicial" => "174"
                        "paginaFinal" => "180"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33377939"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Influence of needle size and injection angle on the distribution pattern of facial soft tissue fillers"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "T&#46; Pavicic"
                            1 => "H&#46;M&#46; Mohmand"
                            2 => "M&#46; Yankova"
                            3 => "T&#46;L&#46; Schenck"
                            4 => "K&#46; Frank"
                            5 => "D&#46;L&#46; Freytag"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "J Cosmet Dermatol"
                        "fecha" => "2019"
                        "paginaInicial" => "1"
                        "paginaFinal" => "7"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Retraction of the plunger on a syringe of hyaluronic acid before injection&#58; are we safe&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46; Wayne"
                            1 => "S&#46; Weinkle"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/DSS.0000000000000557"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Surg"
                        "fecha" => "2015"
                        "volumen" => "41"
                        "paginaInicial" => "S340"
                        "paginaFinal" => "S346"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26618462"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A 10-point plan for avoiding hyaluronic acid dermal filler-related complications during facial aesthetic procedures and algorithms for management"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "I&#46; Heydenrych"
                            1 => "K&#46;M&#46; Kapoor"
                            2 => "K&#46; De Boulle"
                            3 => "G&#46; Goodman"
                            4 => "A&#46; Swift"
                            5 => "N&#46; Kumar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Cosmet and Invest Dermatol"
                        "fecha" => "2018"
                        "volumen" => "11"
                        "paginaInicial" => "603"
                        "paginaFinal" => "611"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Complication management following rejuvenation procedures with hyaluronic acid fillers-an algorithm-based approach"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "P&#46; Snozzi"
                            1 => "J&#46;A&#46; Van Loghem"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/GOX.0000000000002061"
                      "Revista" => array:5 [
                        "tituloSerie" => "Plast Reconstr Surg Glob Open"
                        "fecha" => "2018"
                        "volumen" => "6"
                        "paginaInicial" => "e2061"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30656127"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Arterial occlusion and necrosis following hyaluronic acid injection and a review of the literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "L&#46; Doerfler"
                            1 => "C&#46;W&#46; Hanke"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Drugs Dermatol"
                        "fecha" => "2019"
                        "volumen" => "18"
                        "paginaInicial" => "587"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31251553"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Soft-tissue filler-associated blindness&#58; a systematic review of case reports and case series"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "V&#46; Chatrath"
                            1 => "P&#46;S&#46; Banerjee"
                            2 => "G&#46;J&#46; Goodman"
                            3 => "E&#46; Rahman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Plast Reconstr Surg Glob Open"
                        "fecha" => "2019"
                        "volumen" => "7"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Therapeutic intra-arterial hyaluronidase infusion for ophthalmic artery occlusion following cosmetic facial filler &#40;hyaluronic acid&#41; injection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "B&#46;L&#46; Oh"
                            1 => "C&#46; Jung"
                            2 => "K&#46;H&#46; Park"
                            3 => "Y&#46;J&#46; Hong"
                            4 => "S&#46;J&#46; Woo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Neuroophtalmology"
                        "fecha" => "2014"
                        "volumen" => "38"
                        "paginaInicial" => "39"
                        "paginaFinal" => "43"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
    "agradecimientos" => array:1 [
      0 => array:4 [
        "identificador" => "xack560497"
        "titulo" => "Acknowledgments"
        "texto" => "<p id="par0125" class="elsevierStylePara elsevierViewall">The authors would like to thank Doctor Ignacio Garc&#237;a Doval and Doctor Emilio del R&#237;o de la Torre for their initiative and support&#46;</p>"
        "vista" => "all"
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/15782190/0000011200000009/v1_202110091021/S1578219021002389/v1_202110091021/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "6155"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original Articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/15782190/0000011200000009/v1_202110091021/S1578219021002389/v1_202110091021/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219021002389?idApp=UINPBA000044"
]