<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0376-7892</journal-id>
<journal-title><![CDATA[Cirugía Plástica Ibero-Latinoamericana]]></journal-title>
<abbrev-journal-title><![CDATA[Cir. plást. iberolatinoam.]]></abbrev-journal-title>
<issn>0376-7892</issn>
<publisher>
<publisher-name><![CDATA[Sociedad Española de Cirugía Plástica, Reparadora y Estética (SECPRE)]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0376-78922020000300007</article-id>
<article-id pub-id-type="doi">10.4321/s0376-78922020000300007</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Cicatriz hipertrófica y queloide: rompiendo paradigmas con el uso de Z-plastias]]></article-title>
<article-title xml:lang="en"><![CDATA[Hypertrophic scar and keloid: breaking paradigms with the use of Z-plasties]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Guerrero Serrano]]></surname>
<given-names><![CDATA[Linda]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Fundación del Quemado  ]]></institution>
<addr-line><![CDATA[Bogotá ]]></addr-line>
<country>Colombia</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Banco de Piel de Colombia  ]]></institution>
<addr-line><![CDATA[Bogotá ]]></addr-line>
<country>Colombia</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>06</month>
<year>2020</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>06</month>
<year>2020</year>
</pub-date>
<volume>46</volume>
<numero>2</numero>
<fpage>177</fpage>
<lpage>186</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.isciii.es/scielo.php?script=sci_arttext&amp;pid=S0376-78922020000300007&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.isciii.es/scielo.php?script=sci_abstract&amp;pid=S0376-78922020000300007&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.isciii.es/scielo.php?script=sci_pdf&amp;pid=S0376-78922020000300007&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen  Introducción y objetivo. La cicatriz queloide es uno de los problemas clínicos más frustrantes en la curación de heridas y un gran desafío para los médicos. Los diversos tratamientos (escisión parcial o total), inyección de drogas intralesionales, radioterapia, láser, silicona, prendas de lycra, entre otros, tienen un alto riesgo de recurrencia (10-45%). Los desafíos que enfrenta la comunidad dedicada a la rehabilitación incluyen la investigación del proceso de curación, los efectos de los diferentes factores involucrados en la cicatrización de heridas y el desarrollo de cicatrices, y la mejor combinación de intervenciones quirúrgicas, farmacológicas y terapéuticas para maximizar el resultado. La cirugía se puede realizar para tratar los queloides de dos maneras: primero, resección radical de los queloides y, en segundo lugar, reducción de la masa queloide. El objetivo que proponemos es mejorar las cicatrices hipertróficas y queloides mediante múltiples zetaplastias o con resección parcial más múltiples zetaplastias.  Material y método. Realizamos un estudio prospectivo sobre un total de 335 cicatrices clasificadas según la escala de Vancouver entre febrero de 2013 y julio de 2018. Se intervinieron cicatrices lineales con zetaplastia múltiple teniendo en cuenta las líneas de menor tensión, tanto en cicatrices hipertróficas como en queloides extensos; si el tejido vecino lo permitía, la cicatriz se resecó parcialmente y se hizo zetaplastia múltiple; si el tejido vecino no permitía la resección, se seleccionaron algunas áreas para realizar la primera sesión de zetaplastia y en intervenciones posteriores se realizaron otras para poder intervenir en toda el área en función de las fuerzas de tensión.  Resultados. Revisamos un total de 335 cicatrices, 188 (56.1%) hipertróficas y 147 (43.9%) queloides, en pacientes entre 1 y 56 años, durante un promedio de 13 años. Cara y cuello 123 (37%), extremidades superiores 85 (25,3%), extremidades inferiores 63 (18,8%), tórax 53 (15,8%) y oreja 11 (3,3%) fueron las principales áreas tratadas. De las 123 fotografías intraopoeratorias revisadas, 4 (3%) tenían solo 1 zetaplastia, 3 (2.4%) tenían 2, 27 (21.9%) tenían 3 y 89 (72.3%) más de 4 zetaplastias múltiples (promedio de 6). Con los buenos resultados obtenidos, la cirugía también se realizó en cicatrices durante el proceso de maduración, 3 o 4 meses después de la quemadura. Setenta y ocho pacientes (23.2%) con seguimiento de 5 años no presentan recurrencia, ni 35 (10.4%) a los 4 años.  Conclusiones. La zetaplastia múltiple, con o sin resección parcial de cicatriz hipertófica o queloidea, puede realizarse en cicatrices activas inmaduras, rompiendo el paradigma de esperar hasta que la cicatriz esté madura o incluso cuando los tratamientos terapéuticos hayan fallado. La sutura continua con monofilamento es una contribución técnica que permite reducir el tiempo quirúrgico y facilita la extracción de los puntos.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Background and objective. The keloid scar is one of the most frustrating clinical problems in wound healing and a great challenge for doctors. The various treatments (partial or total excision), intralesional drug injection, radiotherapy, laser, silicone, lycra garments, among others, have a high risk of recurrence (10-45%). The challenges facing the rehabilitation community include the investigation of the healing process, the effects of the different factors involved in wound healing and the development of scars, and the best combination of surgical, pharmacological and therapeutic interventions to maximize the result. Surgery can be performed to treat keloids in two ways: first, radical resection of keloids and, secondly, reduction of keloid mass. Our general objective is to improve hypertrophic and keloid scars with multiple zetaplasties or with partial resection plus multiple zetaplasties.  Methods. A prospective study was conducted on 335 scars classified based on the Vancouver scale between February 2013 and July 2018. Linear scars were intervened with multiple zetaplasty taking into account the lines of least tension; in hypertrophic scars or extensive keoids, if the neighboring tissue allowed it, the scar was partially resected, and perform multiple zetaplasty; if the neighboring tissue did not allow resection, some areas were selected to perform the first zetaplasty session and in subsequent interventions the others were performed to be able to intervene the entire area based on the tension forces.  Results. A total of 335 scars, 188 (56.1%) hypetrophic and 147 (43.9%) keloyds, were treated in patients between 1 and 56 years, for an average of 13 years. Face and neck 123 (37%), upper extremities 85 (25.3%), lower extremities 63 (18.8%), thorax 53 (15.8%) and ear 11 (3.3%) were the main areas treated. Of 123 intraopoeratory photographs reviewed, 4 (3%) had only one zetaplasty, 3 (2.4%) had 2 zetaplasties, 27 (21.9%) had 3 zetaplasties and 89 (72.3%) had more than 4 multiple zetaplasties (with one average of 6). With the good results obtained, surgery was also performed on patients with scars during the maturation process as soon as 3 or 4 months post burn. Seventy eight patients (23.2%) who have 5-year follow-up do not present recurrence nor 35 (10.4%) at 4 years.  Conclusions. Multiple zetaplasty, with or without partial resection of hypertorphic scar o keloyd, can be performed on immature active scars, breaking the paradigm of waiting until the scar is mature or even when therapeutic treatments have failed. The continuous suture with monofilament is a technical contribution that allows to reduce surgical time and facilitates the removal of the stitches.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Queloide]]></kwd>
<kwd lng="es"><![CDATA[Cicatriz hipertrófica]]></kwd>
<kwd lng="es"><![CDATA[Zetaplastia]]></kwd>
<kwd lng="es"><![CDATA[Zetaplastias múltiples]]></kwd>
<kwd lng="es"><![CDATA[Cicatriz activa]]></kwd>
<kwd lng="en"><![CDATA[Keloid]]></kwd>
<kwd lng="en"><![CDATA[Hypertrophic scar]]></kwd>
<kwd lng="en"><![CDATA[Zetaplasty]]></kwd>
<kwd lng="en"><![CDATA[Multiple zetaplasties]]></kwd>
<kwd lng="en"><![CDATA[partial resection]]></kwd>
<kwd lng="en"><![CDATA[Active scar]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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