COLGAJO DE ABBE PDF

Directory of Open Access Journals Sweden. Bakamjian introduced the deltopectoral skin flap en , and there after it was used extensively for reconstructive surgery of the head and neck. This work is a review of the reconstructive experience afforded by several authors and evaluates the technical modifications used to enhance the reliability of this flap. The authors describe the ability of the deltopectoral flap raised bilaterally to provide tissue enough for an extensive irradiated neck, allowing resurfacing a bilateral cutaneous defect after radiation therapy.

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In the year has been indexed in the Medlinedatabase, and has become a vehicle for expressing the most current Spanish medicine and modern. All articles are subjected to a rigorous process of revision in pairs, and careful editing for literary and scientific style. CiteScore measures average citations received per document published. Read more. SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact.

SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field. A broad range of skin flaps can be used to repair facial surgical defects after the excision of a tumor. The aim of our study was to develop a practical guideline covering the most useful skin grafts for each of the distinct facial cosmetic units..

This was a multicenter study in which 10 dermatologists with extensive experience in reconstructive surgery chose their preferred technique for each cosmetic unit. The choice of flaps was based on personal experience, taking into account factors such as suitability of the reconstruction technique for the specific defect, the final cosmetic result, surgical difficulty, and risk of complications. Each dermatologist proposed 2 flaps in order of preference for each cosmetic subunit.

A score of 10 was given to the first flap and a score of 5 to the second.. The total score obtained for each of the options proposed by the participating dermatologists was used to draw up a list of the 3 best grafts for each site. There was notable unanimity of criteria among most of the dermatologists for reconstructive techniques such as the glabellar flap for defects of the medial canthus of the eye, the bilateral advancement flag flap or H flap for the forehead, the rotary door flap for the auricle of the ear, the Mustarde flap for the infraorbital cheek, the O-Z rotation flap for the scalp, the Tenzel flap for the lower eyelid, and the island flap for the upper lip..

The results of this study will be useful as a practical guide to choosing the best reconstruction technique for each of the facial cosmetic units.. The reconstruction of large surgical defects after the surgical excision of skin tumors usually requires the use of skin flaps. For optimal results, it is important to take into account the concept of facial cosmetic units.

The main cosmetic units are in turn subdivided into various subunits because of the anatomic complexity of some regions, such as the nose and the auricles of the ear Fig.

Certain fundamental norms based on these cosmetic units exist to help us achieve minimally visible scars. A flap must be designed within the limits of the cosmetic unit in which the primary defect is located, and the incisions should preferably be placed along the borders of the units, without crossing them.

It should also be noted that best results are obtained with the reconstruction of complete cosmetic units, even if the defect affects less than the whole unit, and that the reconstruction of defects that affect various cosmetic units should be undertaken considering each individual unit, compartmentalizing the repair.

However, there is considerable variability in the choice of the best flap for each site. Although general recommendations exist according to the topographic site, 2—5 no consensus guidelines have been published to specify which flap should be used in each cosmetic unit. In order to draw up a practical guideline on the most useful flaps for each one the distinct facial cosmetic units, we undertook a study with the participation of 10 dermatologists with extensive experience in reconstructive surgery, who stated their preferred flaps for each site.

We have found no evidence that any study of these characteristics has yet been performed in Spain. Main facial cosmetic units and subunits. Ten dermatologists were selected from different surgical schools across the Iberian Peninsula 9 Spanish and 1 Portuguese. They were sent a questionnaire with a diagram of all the facial cosmetic subunits and they were asked to choose 2 flaps, in order of preference, for each subunit. The choice of flaps was based on each dermatologist's personal experience.

The suitability of a flap depended on factors such as the objective adaptation of flap design to the site of the defect, final cosmetic result, surgical complexity, and risk of complications.

To unify flap classification criteria, we decided to use the concept of the main movement performed during movement of the flap—rotation, transposition, or advancement—and the participating dermatologists were sent a detailed classification so that the same terminology was used in all cases. Transposition flaps were subdivided into rhomboidal Limberg, Dufourmentel , bilobar, and interpolation nasolabial, paramedian forehead flaps.

Advancement flaps were subdivided into unilateral, bilateral flag , A-T, V-Y, crescentic, and island. The first flap chosen was assigned 10 points and the second 5.

The 3 best flaps for each site were thus determined according to the sum of the scores obtained from each participating dermatologist. All the reconstruction techniques chosen by each dermatologist for each facial cosmetic subunit are listed in order of preference in the Additional Material , together with the final score obtained for each reconstruction technique in each cosmetic subunit. Dermatologic surgical practice varies considerably in Spain depending on the surgical school in which a surgeon has trained.

This data compilation has enabled us to draw certain conclusions that represent an interesting common viewpoint on the choice of reconstructive technique.

First, the flap with the highest score was the glabellar flap for defects of the medial canthus of the eye. This flap achieved the maximum score of points, reflecting unanimity of all the participating dermatologists for this cosmetic unit.

The agreement on the use of these flaps as best option in these cosmetic units, supported by the extensive surgical experience of the participating dermatologists, allows us to confirm them as the flaps of first choice for each of these sites.

In the analysis of the cosmetic units that generated fewest different repair options, the parotid-masseteric subunit of the cheek stood out for having only 2 flaps nominated: the rhomboid transposition Limberg flap and the lateral rotation flap.

This finding also confirmed unanimity of criteria in this cosmetic subunit. In contrast, the sites for which the largest number of different flaps were proposed were the antihelix of the auricle of the ear and 3 subunits of the external nose: the lateral wall, the tip, and the dorsum of the nose. This diversity of flaps suggests a lack of unanimity of criteria between participants; this can be explained by the surgical complexity of these areas. Another possible cause is the use of different flaps depending on the size of the defect within a single cosmetic subunit.

With respect to the most frequently chosen flaps according to the main movement to be made, advancement flaps came at the top of the list, followed by transposition flaps and, finally, rotation flaps. However, the individual flap most widely used in the overall group of facial cosmetic units was the Limberg flap. This flap can therefore be considered the most versatile flap for use in almost all the cosmetic subunits.

But perhaps the most important outcome of the analysis of these data is the elaboration of a practical guideline to choose the ideal flap in each cosmetic subunit Table 1. A, The flag flap was chosen as the flap of choice for the forehead. B, The Limberg flap was the flap of choice for the lateral forehead. C, The subcutaneous island pedicle flap was the flap of choice for the brow.

Photographs courtesy of Dr. In the lateral subunit of the forehead, the flap of choice was the Limberg flap Fig.

In the brow, the preferred flap was the island flap Fig. For the dorsum of the nose, the flap of choice was the Rieger flap Fig. A, The Rieger flap for the dorsum of the nose. B, The nasolabial flap for reconstruction of the nasal ala. C, The bilobar flap for the tip of the nose. Ricardo Ruiz Villaverde.

On the lateral wall of the nose, the first choice of flap was the Limberg flap, 8 followed by the lateral advancement flap and, in third place, the lateral advancement flap with a double Burow or Webster triangle.

The majority of participants in the survey most commonly used a nasolabial transposition flap to reconstruct the nasal ala Fig. There was considerable variability in the choice of flap for the repair of defects on the tip of the nose, but the bilobar flap Fig. The columella was also a cosmetic subunit in which it was difficult to reach consensus because few cases affect this site. With respect to the upper eyelid, 12 few defects cannot be closed by direct suture.

When a flap is required, the lateral advancement flap gained the highest score, followed by the reverse Tripier flap and the reverse Tenzel flap. The lower eyelid, on the other hand, is an area that requires flaps even for small defects due to the risk of ectropion.

A, The Tenzel flap for the lower eyelid. B, The Limberg flap for the lateral canthus of the eye. C, The glabellar flap for the medial canthus of the eye. For defects of the lateral canthus of the eye, the Limberg flap Fig. The glabellar flap Fig. B, The Limberg flap was the flap of choice for the zygomatic, buccal, and parotid-masseteric subunits of the cheek.

The Limberg flap was preferred for the zygomatic region of the cheek Fig. The Limberg flap was also the most voted for the buccal cheek, followed by the crescentic flap and the lateral advancement flap. Curiously, only 2 flaps were nominated for the parotid-masseteric region of the cheek, the Limberg flap in first place, and the lateral rotation flap in second. The central area philtrum of the upper lip was reconstructed by the majority of participants using the A-T flap Fig.

A, A-T flap for the philtrum of the lip. B, Subcutaneous island pedicle flap for the upper lip. C, The bilateral perialar horizontal advancement flap for the vermilion of the upper lip. Photograph A courtesy of Dr. Photograph B courtesy of Dr. Photograph C courtesy of Dr. Francisco Vilchez. In the lateral zones of the upper lip, the island flap Fig.

When a simple wedge is insufficient to repair a full-thickness defect of the vermilion of upper lip and a flap must be used, the bilateral perialar horizontal advancement flap described by Celsus Fig.

The most widely used flap in the vermilion of lower lip was the advancement flap with double crescents from the chin, proposed by Turgut 20 Fig. The double labiomental advancement flap for the vermilion of the lower lip. Photograph courtesy of Dr. In the central region of the lower lip, the flap of choice was the A-T flap, followed by the flag flap and the M-plasty.

The majority of participants reconstructed the chin using an A-T flap Fig. Ana Miragaya. The flap that received most votes for the helix of the ears was the helical advancement flap Fig. A, The helical advancement flap was the flap of choice for the helix of the ear. B, The revolving-door flap for defects of the concha of the ear. C, The Limberg flap for the earlobe. D, The Limberg flap for retroauricular defects.

ALANYA RESEGUIDE PDF

The use of a modified abbé island flap to reconstruct primary lip defects of over 80 %

In the year has been indexed in the Medlinedatabase, and has become a vehicle for expressing the most current Spanish medicine and modern. All articles are subjected to a rigorous process of revision in pairs, and careful editing for literary and scientific style. CiteScore measures average citations received per document published. Read more. SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact.

ADVANCED ENGINEERING MATHEMATICS 9TH EDITION BY ERWIN KREYSZIG PDF

Guidance flap choice for lip cancer: Principles, timing and esthetic-functional results. The purpose of this study is to help in the choice of an appropriate reconstructive technique by reference to the dimensions of the defect, the required functional and esthetic outcomes, and retention of adequate surgical safety margins to prevent primary tumor recurrence. Material and methods: A total of patients were treated. We indicate how the most appropriate reconstructive method may be chosen, with reference to the size and position of the cancer and depth of tissue infiltration.

EROS ELECTRONICO ROMAN GUBERN PDF

Directory of Open Access Journals Sweden. En los 13 casos se obtuvo buena cobertura del defecto a cubrir. Dos pacientes necesitaron tenolisis y dos zetaplastias. Todos los colgajos realizados en miembro inferior permitieron la vuelta a la actividad deportiva normal. Aug 8,

JIS G3192 PDF

Skip to search form Skip to main content You are currently offline. Some features of the site may not work correctly. DOI: Roskies and Alex M. View on Springer. Save to Library. Create Alert.

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