array:24 [
  "pii" => "S1578219018303767"
  "issn" => "15782190"
  "doi" => "10.1016/j.adengl.2018.10.018"
  "estado" => "S300"
  "fechaPublicacion" => "2018-12-01"
  "aid" => "1991"
  "copyright" => "Elsevier España, S.L.U. and AEDV"
  "copyrightAnyo" => "2018"
  "documento" => "simple-article"
  "crossmark" => 1
  "subdocumento" => "crp"
  "cita" => "Actas Dermosifiliogr. 2018;109:917-9"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 24
    "HTML" => 24
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0001731018302552"
      "issn" => "00017310"
      "doi" => "10.1016/j.ad.2018.01.011"
      "estado" => "S300"
      "fechaPublicacion" => "2018-12-01"
      "aid" => "1991"
      "copyright" => "AEDV"
      "documento" => "simple-article"
      "crossmark" => 1
      "subdocumento" => "crp"
      "cita" => "Actas Dermosifiliogr. 2018;109:917-9"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 258
        "formatos" => array:2 [
          "HTML" => 187
          "PDF" => 71
        ]
      ]
      "es" => array:11 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">V&#205;DEOS DE CIRUG&#205;A DERMATOL&#211;GICA</span>"
        "titulo" => "Reconstrucci&#243;n palpebral inferior mediante &#171;colgajo triangular de Mutaf&#187;"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "917"
            "paginaFinal" => "919"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Using a &#8220;Mutaf Triangular Flap&#8221; for Lower Eyelid Reconstruction"
          ]
        ]
        "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" => 1553
                "Ancho" => 2833
                "Tamanyo" => 814366
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Colgajo triangular de Mutaf&#46; A&#46; Defecto primario triangulado&#46; B&#46; Colgajo disecado compuesto por 2 tri&#225;ngulos opuestos&#46; C&#46; Posicionamiento final del colgajo&#46; D y E&#46; Posoperatorio inmediato y tard&#237;o &#40;8 semanas&#41;&#46; Visi&#243;n frontal y lateral&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "P&#46; Fern&#225;ndez Canga, E&#46; Varas Meis, J&#46; Casti&#241;eiras Gonz&#225;lez, M&#46; Espasand&#237;n Arias, M&#46;&#193;&#46; Rodr&#237;guez Prieto"
            "autores" => array:5 [
              0 => array:2 [
                "nombre" => "P&#46;"
                "apellidos" => "Fern&#225;ndez Canga"
              ]
              1 => array:2 [
                "nombre" => "E&#46;"
                "apellidos" => "Varas Meis"
              ]
              2 => array:2 [
                "nombre" => "J&#46;"
                "apellidos" => "Casti&#241;eiras Gonz&#225;lez"
              ]
              3 => array:2 [
                "nombre" => "M&#46;"
                "apellidos" => "Espasand&#237;n Arias"
              ]
              4 => array:2 [
                "nombre" => "M&#46;&#193;&#46;"
                "apellidos" => "Rodr&#237;guez Prieto"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S1578219018303767"
          "doi" => "10.1016/j.adengl.2018.10.018"
          "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/S1578219018303767?idApp=UINPBA000044"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731018302552?idApp=UINPBA000044"
      "url" => "/00017310/0000010900000010/v1_201812060614/S0001731018302552/v1_201812060614/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S1578219018303743"
    "issn" => "15782190"
    "doi" => "10.1016/j.adengl.2018.10.016"
    "estado" => "S300"
    "fechaPublicacion" => "2018-12-01"
    "aid" => "1988"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and AEDV"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "sco"
    "cita" => "Actas Dermosifiliogr. 2018;109:920"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 11
      "formatos" => array:3 [
        "EPUB" => 1
        "HTML" => 7
        "PDF" => 3
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Images in Dermatology</span>"
      "titulo" => "Pemphigus Vegetans in the Inguinal Folds"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:1 [
          "paginaInicial" => "920"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "P&#233;nfigo vegetante en pliegues inguinales"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:6 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 563
              "Ancho" => 750
              "Tamanyo" => 58096
            ]
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "R&#46; Rodr&#237;guez-Lojo, M&#46;M&#46; Otero-Rivas, T&#46; Usero-B&#225;rcena, I&#46; Casti&#241;eiras-Mato"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "Rodr&#237;guez-Lojo"
            ]
            1 => array:2 [
              "nombre" => "M&#46;M&#46;"
              "apellidos" => "Otero-Rivas"
            ]
            2 => array:2 [
              "nombre" => "T&#46;"
              "apellidos" => "Usero-B&#225;rcena"
            ]
            3 => array:2 [
              "nombre" => "I&#46;"
              "apellidos" => "Casti&#241;eiras-Mato"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0001731018302527"
        "doi" => "10.1016/j.ad.2017.07.026"
        "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/S0001731018302527?idApp=UINPBA000044"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018303743?idApp=UINPBA000044"
    "url" => "/15782190/0000010900000010/v1_201812060634/S1578219018303743/v1_201812060634/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S1578219018303718"
    "issn" => "15782190"
    "doi" => "10.1016/j.adengl.2017.09.006"
    "estado" => "S300"
    "fechaPublicacion" => "2018-12-01"
    "aid" => "1884"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and AEDV"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "sco"
    "cita" => "Actas Dermosifiliogr. 2018;109:915-6"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 5
      "formatos" => array:2 [
        "HTML" => 4
        "PDF" => 1
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Resident&#39;s Forum</span>"
      "titulo" => "RF-Topical Rapamycin as an Adjuvant to Laser Treatment in Capillary Malformations"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "915"
          "paginaFinal" => "916"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "FR- Rapamicina t&#243;pica adyuvante al tratamiento con l&#225;ser en malformaciones capilares"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "A&#46; Alegre-S&#225;nchez, P&#46; Boixeda"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Alegre-S&#225;nchez"
            ]
            1 => array:2 [
              "nombre" => "P&#46;"
              "apellidos" => "Boixeda"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0001731018300061"
        "doi" => "10.1016/j.ad.2017.09.020"
        "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/S0001731018300061?idApp=UINPBA000044"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018303718?idApp=UINPBA000044"
    "url" => "/15782190/0000010900000010/v1_201812060634/S1578219018303718/v1_201812060634/en/main.assets"
  ]
  "en" => array:16 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Videos of Surgical Procedures in Dermatology</span>"
    "titulo" => "Using a &#8220;Mutaf Triangular Flap&#8221; for Lower Eyelid Reconstruction"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "917"
        "paginaFinal" => "919"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "P&#46; Fern&#225;ndez Canga, E&#46; Varas Meis, J&#46; Casti&#241;eiras Gonz&#225;lez, M&#46; Espasand&#237;n Arias, M&#46;&#193;&#46; Rodr&#237;guez Prieto"
        "autores" => array:5 [
          0 => array:4 [
            "nombre" => "P&#46;"
            "apellidos" => "Fern&#225;ndez Canga"
            "email" => array:1 [
              0 => "paulafcanga&#64;gmail&#46;com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:2 [
            "nombre" => "E&#46;"
            "apellidos" => "Varas Meis"
          ]
          2 => array:2 [
            "nombre" => "J&#46;"
            "apellidos" => "Casti&#241;eiras Gonz&#225;lez"
          ]
          3 => array:2 [
            "nombre" => "M&#46;"
            "apellidos" => "Espasand&#237;n Arias"
          ]
          4 => array:2 [
            "nombre" => "M&#46;&#193;&#46;"
            "apellidos" => "Rodr&#237;guez Prieto"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Servicio de Dermatolog&#237;a&#44; Complejo Asistencial Universitario de Le&#243;n&#44; Le&#243;n&#44; Espa&#241;a"
            "identificador" => "aff0005"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Reconstrucci&#243;n palpebral inferior mediante &#171;colgajo triangular de Mutaf&#187;"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 431
            "Ancho" => 1700
            "Tamanyo" => 112808
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Examination of palpebral laxity&#46; A&#44; Snap test&#58; slow repositioning of the eyelid&#46; B&#44; Medial traction&#58; examination of lateral canthal laxity based on increase in the external angle&#46; C&#44; Lateral traction&#58; assessment of medial canthal laxity based on the degree of movement of the tear duct&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The infraorbital region is a unique anatomic subunit&#44; close to structures of functional and esthetic importance&#44; such as the lower eyelid&#44; nasal ala and oral commissure&#44; which should be taken into consideration during reconstructive surgery&#46; The main cause of distortion is traction secondary to closure with excessive tension or to scar contraction&#46; The absence of folds in which to hide scars is an added difficulty&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">One of the principal complications when reconstructing infraorbital defects is postoperative ectropion&#46; A thorough examination of the eyelid prior to surgery is therefore required to identify signs of excessive laxity &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; In the event of muscle wasting that may favor ectropion&#44; the need for an associated eyelid-suspension technique &#40;e&#46;g&#46;&#44; canthopexy associated with the flap chosen to close the defect&#41; should be considered&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The Mutaf triangular flap technique was described in 2011 by Mutaf et al&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a> for the reconstruction of infraorbital defects&#46; It is based on 2 triangular transposition flaps treated as an unequal Z-plasty&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Technical Description</span><p id="par0020" class="elsevierStylePara elsevierViewall">The technique requires converting the surgical defect into an isosceles triangle with the base superior &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A&#41;&#46; Based on this triangle and its dimensions&#44; 2 opposing triangles are then traced &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>D-F&#41;&#46; One triangle is transposed to cover the original defect and the second triangle will cover the defect of the donor region &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>B and <span class="elsevierStyleSmallCaps">C</span>&#41;&#46; The suture line and&#44; therefore&#44; the resulting scar will follow the tension lines of the cheek&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">2&#44;3</span></a></p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">We report our experience in performing the Mutaf flap in a patient with a large defect in the palpebromalar region following Mohs surgery for basal cell carcinoma &#40;<span class="elsevierStyleItalic">see video</span>&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The patient was placed under general anesthesia and we began the incision and dissection of the tissue to convert the primary defect into a triangle&#46; When this triangle had been defined&#44; the first part of the flap was incised and the flap was dissected superficially in a subcutaneous plane&#46; The second triangle was then raised and the final positioning of both flaps was verified &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>A-C&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Before commencing suturing&#44; careful hemostasis was performed&#44; the uppermost part of the flap was thinned to ensure it was as similar as possible to the palpebral skin&#44; and the lateral orbital edge was attached by means of an anchor stitch using a 3-0 absorbable braided suture &#40;Vicryl<span class="elsevierStyleSup">&#174;</span>&#41; to prevent retraction&#46; Finally&#44; continuous suture of the flap was performed using 4-0 silk and the dog-ears at the distal end were corrected &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>D and E&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Indication</span><p id="par0040" class="elsevierStylePara elsevierViewall">Medium and large infraorbital skin defects&#44; for which other&#44; simpler&#44; reconstructive techniques are scheduled may give rise to postoperative ectropion or poor esthetic results&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Contraindications</span><p id="par0045" class="elsevierStylePara elsevierViewall">No absolute contraindications are known&#46; Abnormal coagulation and factors that predispose the patient to cutaneous ischemia &#40;smoking&#44; prior radiation therapy&#44; diabetic foot&#44; etc&#46;&#41;&#44; which may compromise the viability of the flap&#44; may be considered relative contraindications&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Complications</span><p id="par0050" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0055" class="elsevierStylePara elsevierViewall">Surgical wound infection&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0060" class="elsevierStylePara elsevierViewall">Hemorrhage&#44; hematoma&#44; and skin necrosis&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0065" class="elsevierStylePara elsevierViewall">Scarring ectropion&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0070" class="elsevierStylePara elsevierViewall">Temporary or permanent altered sensation owing to damage to nerve structures&#46;</p></li></ul></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusion</span><p id="par0075" class="elsevierStylePara elsevierViewall">The Mutaf triangular flap technique is a good&#44; original reconstructive option in medium and large infraorbital defects&#44; where&#44; owing to the risk of palpebral retraction&#44; other flap techniques do not provide an adequate alternative and the use of grafts may compromise the esthetic results&#46; The operation is laborious but not technically complex and&#44; as can be seen&#44; provides good functional and esthetic results &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figs&#46; 3</a>D and E&#41;&#46; Appropriate examination of palpebral laxity is required before designing surgery of the infraorbital region&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of Interest</span><p id="par0080" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:8 [
        0 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        1 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Technical Description"
        ]
        2 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Indication"
        ]
        3 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Contraindications"
        ]
        4 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Complications"
        ]
        5 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Conclusion"
        ]
        6 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Conflicts of Interest"
        ]
        7 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Fern&#225;ndez Canga P&#44; Varas Meis E&#44; Casti&#241;eiras Gonz&#225;lez J&#44; Espasand&#237;n Arias M&#44; Rodr&#237;guez Prieto M&#193;&#46; Reconstrucci&#243;n palpebral inferior mediante &#171;colgajo triangular de Mutaf&#187;&#46; Actas Dermosifiliogr&#46; 2018&#59;109&#58;917&#8211;919&#46;</p>"
      ]
    ]
    "apendice" => array:1 [
      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0090" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary data"
            "identificador" => "sec0045"
          ]
        ]
      ]
    ]
    "multimedia" => array:4 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 431
            "Ancho" => 1700
            "Tamanyo" => 112808
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Examination of palpebral laxity&#46; A&#44; Snap test&#58; slow repositioning of the eyelid&#46; B&#44; Medial traction&#58; examination of lateral canthal laxity based on increase in the external angle&#46; C&#44; Lateral traction&#58; assessment of medial canthal laxity based on the degree of movement of the tear duct&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1494
            "Ancho" => 2834
            "Tamanyo" => 565340
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Design of the Mutaf triangular flap&#46; A&#44; Conversion of the primary defect into a triangle&#46; B&#44; Rotation of the second triangle required to cover the primary defect &#40;arrow&#41;&#46; C&#46; Rotation of the third triangle required to cover the secondary defect &#40;arrow&#41;&#46; D&#44; The first part of the flap is traced at the same distance as the upper line of the defect converted to a triangle &#40;yellow dotted line&#41;&#46; E&#44; The length of the flap must be the same as that of the internal face of the defect &#40;purple dotted line&#41; it will be moved toward &#40;arrow&#41;&#46; F&#44; Extension of the vertex of the defect to define the third triangle &#40;red dotted line&#41;&#46; Angles of the vertices of the 3 triangles&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1553
            "Ancho" => 2833
            "Tamanyo" => 814366
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Mutaf triangular flap&#46; A&#44; Primary defect converted to a triangle&#46; B&#44; Raised flap made up of 3 opposing triangles&#46; C&#44; Final positioning of the flap&#46; D and E&#44; Immediate and later postoperative period &#40;8 weeks&#41;&#46; Front and side view&#46;</p>"
        ]
      ]
      3 => array:5 [
        "identificador" => "upi0005"
        "tipo" => "MULTIMEDIAECOMPONENTE"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "Ecomponente" => array:3 [
          "fichero" => "mmc1.mp4"
          "ficheroTamanyo" => 178385860
          "Video" => array:2 [
            "mp4" => array:5 [
              "fichero" => "mmc1.m4v"
              "poster" => "mmc1.jpg"
              "tiempo" => 0
              "alto" => 0
              "ancho" => 0
            ]
            "flv" => array:5 [
              "fichero" => "mmc1.flv"
              "poster" => "mmc1.jpg"
              "tiempo" => 0
              "alto" => 0
              "ancho" => 0
            ]
          ]
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:3 [
            0 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cirug&#237;a reconstructiva de la regi&#243;n cigom&#225;tica-medial de la mejilla&#58; presentaci&#243;n de 5 casos"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46;G&#46; P&#233;rez-Paredes"
                            1 => "B&#46; Gonz&#225;lez-Sixto"
                            2 => "M&#46;M&#46; Otero-Rivas"
                            3 => "M&#46; Rodr&#237;guez-Prieto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.adengl.2012.11.029"
                      "Revista" => array:6 [
                        "tituloSerie" => "Actas Dermosifiliogr&#46;"
                        "fecha" => "2014"
                        "volumen" => "105"
                        "paginaInicial" => "e27"
                        "paginaFinal" => "e31"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24718266"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A new technique for closure of infraorbital defects"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Mutaf"
                            1 => "E&#46; G&#252;nal"
                            2 => "M&#46; Temel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/SAP.0b013e31820d6830"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Plast Surg&#46;"
                        "fecha" => "2011"
                        "volumen" => "67"
                        "paginaInicial" => "600"
                        "paginaFinal" => "605"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21659850"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mutaf triangular flap technique in the repair of infraorbital skin losses&#58; Report of 5 cases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "R&#46; Cecchi"
                            1 => "L&#46; Bartoli"
                            2 => "L&#46; Brunetti"
                            3 => "G&#46; Troiano"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4103/0974-2077.146679"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Cutan Aesthet Surg&#46;"
                        "fecha" => "2014"
                        "volumen" => "7"
                        "paginaInicial" => "176"
                        "paginaFinal" => "177"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25538443"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1474442210701319"
                          "estado" => "S300"
                          "issn" => "14744422"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/15782190/0000010900000010/v1_201812060634/S1578219018303767/v1_201812060634/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "6209"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Videos of Surgical Procedures in Dermatology"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010900000010/v1_201812060634/S1578219018303767/v1_201812060634/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018303767?idApp=UINPBA000044"
]
Compartir
Información de la revista
Vol. 109. Núm. 10.
Páginas 917-919 (diciembre 2018)
Visitas
5430
Vol. 109. Núm. 10.
Páginas 917-919 (diciembre 2018)
Videos of Surgical Procedures in Dermatology
Acceso a texto completo
Using a “Mutaf Triangular Flap” for Lower Eyelid Reconstruction
Reconstrucción palpebral inferior mediante «colgajo triangular de Mutaf»
Visitas
5430
P. Fernández Canga
Autor para correspondencia
paulafcanga@gmail.com

Corresponding author.
, E. Varas Meis, J. Castiñeiras González, M. Espasandín Arias, M.Á. Rodríguez Prieto
Servicio de Dermatología, Complejo Asistencial Universitario de León, León, España
Este artículo ha recibido
Información del artículo
Texto completo
Bibliografía
Descargar PDF
Estadísticas
Figuras (3)
Mostrar másMostrar menos
Material adicional (1)
Texto completo
Introduction

The infraorbital region is a unique anatomic subunit, close to structures of functional and esthetic importance, such as the lower eyelid, nasal ala and oral commissure, which should be taken into consideration during reconstructive surgery. The main cause of distortion is traction secondary to closure with excessive tension or to scar contraction. The absence of folds in which to hide scars is an added difficulty.1

One of the principal complications when reconstructing infraorbital defects is postoperative ectropion. A thorough examination of the eyelid prior to surgery is therefore required to identify signs of excessive laxity (Fig. 1). In the event of muscle wasting that may favor ectropion, the need for an associated eyelid-suspension technique (e.g., canthopexy associated with the flap chosen to close the defect) should be considered.

Figure 1.

Examination of palpebral laxity. A, Snap test: slow repositioning of the eyelid. B, Medial traction: examination of lateral canthal laxity based on increase in the external angle. C, Lateral traction: assessment of medial canthal laxity based on the degree of movement of the tear duct.

(0.11MB).

The Mutaf triangular flap technique was described in 2011 by Mutaf et al.2 for the reconstruction of infraorbital defects. It is based on 2 triangular transposition flaps treated as an unequal Z-plasty.

Technical Description

The technique requires converting the surgical defect into an isosceles triangle with the base superior (Fig. 2A). Based on this triangle and its dimensions, 2 opposing triangles are then traced (Fig. 2D-F). One triangle is transposed to cover the original defect and the second triangle will cover the defect of the donor region (Fig. 2B and C). The suture line and, therefore, the resulting scar will follow the tension lines of the cheek.2,3

Figure 2.

Design of the Mutaf triangular flap. A, Conversion of the primary defect into a triangle. B, Rotation of the second triangle required to cover the primary defect (arrow). C. Rotation of the third triangle required to cover the secondary defect (arrow). D, The first part of the flap is traced at the same distance as the upper line of the defect converted to a triangle (yellow dotted line). E, The length of the flap must be the same as that of the internal face of the defect (purple dotted line) it will be moved toward (arrow). F, Extension of the vertex of the defect to define the third triangle (red dotted line). Angles of the vertices of the 3 triangles.

(0.54MB).

We report our experience in performing the Mutaf flap in a patient with a large defect in the palpebromalar region following Mohs surgery for basal cell carcinoma (see video).

The patient was placed under general anesthesia and we began the incision and dissection of the tissue to convert the primary defect into a triangle. When this triangle had been defined, the first part of the flap was incised and the flap was dissected superficially in a subcutaneous plane. The second triangle was then raised and the final positioning of both flaps was verified (Fig. 3A-C).

Figure 3.

Mutaf triangular flap. A, Primary defect converted to a triangle. B, Raised flap made up of 3 opposing triangles. C, Final positioning of the flap. D and E, Immediate and later postoperative period (8 weeks). Front and side view.

(0.78MB).

Before commencing suturing, careful hemostasis was performed, the uppermost part of the flap was thinned to ensure it was as similar as possible to the palpebral skin, and the lateral orbital edge was attached by means of an anchor stitch using a 3-0 absorbable braided suture (Vicryl®) to prevent retraction. Finally, continuous suture of the flap was performed using 4-0 silk and the dog-ears at the distal end were corrected (Fig. 3D and E).

Indication

Medium and large infraorbital skin defects, for which other, simpler, reconstructive techniques are scheduled may give rise to postoperative ectropion or poor esthetic results.

Contraindications

No absolute contraindications are known. Abnormal coagulation and factors that predispose the patient to cutaneous ischemia (smoking, prior radiation therapy, diabetic foot, etc.), which may compromise the viability of the flap, may be considered relative contraindications.

Complications

  • Surgical wound infection.

  • Hemorrhage, hematoma, and skin necrosis.

  • Scarring ectropion.

  • Temporary or permanent altered sensation owing to damage to nerve structures.

Conclusion

The Mutaf triangular flap technique is a good, original reconstructive option in medium and large infraorbital defects, where, owing to the risk of palpebral retraction, other flap techniques do not provide an adequate alternative and the use of grafts may compromise the esthetic results. The operation is laborious but not technically complex and, as can be seen, provides good functional and esthetic results (Figs. 3D and E). Appropriate examination of palpebral laxity is required before designing surgery of the infraorbital region.

Conflicts of Interest

The authors declare that they have no conflicts of interest.

References
[1]
M.G. Pérez-Paredes, B. González-Sixto, M.M. Otero-Rivas, M. Rodríguez-Prieto.
Cirugía reconstructiva de la región cigomática-medial de la mejilla: presentación de 5 casos.
Actas Dermosifiliogr., 105 (2014), pp. e27-e31
[2]
M. Mutaf, E. Günal, M. Temel.
A new technique for closure of infraorbital defects.
Ann Plast Surg., 67 (2011), pp. 600-605
[3]
R. Cecchi, L. Bartoli, L. Brunetti, G. Troiano.
Mutaf triangular flap technique in the repair of infraorbital skin losses: Report of 5 cases.
J Cutan Aesthet Surg., 7 (2014), pp. 176-177

Please cite this article as: Fernández Canga P, Varas Meis E, Castiñeiras González J, Espasandín Arias M, Rodríguez Prieto MÁ. Reconstrucción palpebral inferior mediante «colgajo triangular de Mutaf». Actas Dermosifiliogr. 2018;109:917–919.

Copyright © 2018. Elsevier España, S.L.U. and AEDV
Descargar PDF
Idiomas
Actas Dermo-Sifiliográficas
Opciones de artículo
Herramientas
Material suplementario
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?