<?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>1405-0099</journal-id>
<journal-title><![CDATA[Cirujano general]]></journal-title>
<abbrev-journal-title><![CDATA[Cir. gen]]></abbrev-journal-title>
<issn>1405-0099</issn>
<publisher>
<publisher-name><![CDATA[Asociación Mexicana de Cirugía General A.C.]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1405-00992023000300160</article-id>
<article-id pub-id-type="doi">10.35366/112925</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Manejo quirúrgico versus tratamiento médico en loxoscelismo cutáneo: revisión sistemática y actualización]]></article-title>
<article-title xml:lang="en"><![CDATA[Surgical management versus medical treatment of cutaneous loxoscelism: a sistematic review and update]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Olan De Los Santos]]></surname>
<given-names><![CDATA[Aldo Israel]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Manzo Castrejón]]></surname>
<given-names><![CDATA[Hilda Alejandra]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Corona Díaz]]></surname>
<given-names><![CDATA[Enrique]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Hurtado Miranda]]></surname>
<given-names><![CDATA[Grecia Fernanda]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Franco Ponce]]></surname>
<given-names><![CDATA[Leonel Eduardo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Arreola Pérez]]></surname>
<given-names><![CDATA[Juan Daniel]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Arellano Romero]]></surname>
<given-names><![CDATA[Uriel Esaid]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Alanís Nava]]></surname>
<given-names><![CDATA[Juan Manuel]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Ortiz Márquez]]></surname>
<given-names><![CDATA[Jonathan Javier]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Rodríguez]]></surname>
<given-names><![CDATA[Iván San Pedro]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado Hospital General Tacuba ]]></institution>
<addr-line><![CDATA[Ciudad de México ]]></addr-line>
<country>México</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado Hospital General Tacuba ]]></institution>
<addr-line><![CDATA[Ciudad de México ]]></addr-line>
<country>México</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Instituto Mexicano del Seguro Social Centro Médico Nacional La Raza ]]></institution>
<addr-line><![CDATA[Ciudad de México ]]></addr-line>
<country>Mexico</country>
</aff>
<aff id="Af4">
<institution><![CDATA[,Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado Hospital General Tacuba ]]></institution>
<addr-line><![CDATA[Ciudad de México ]]></addr-line>
<country>México</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>09</month>
<year>2023</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>09</month>
<year>2023</year>
</pub-date>
<volume>45</volume>
<numero>3</numero>
<fpage>160</fpage>
<lpage>175</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_arttext&amp;pid=S1405-00992023000300160&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_abstract&amp;pid=S1405-00992023000300160&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_pdf&amp;pid=S1405-00992023000300160&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen:  Antecedentes y objetivo:  Realizar una revisión sistemática acerca del manejo del loxoscelismo cutáneo para analizar la efectividad de las terapias actuales sobre el manejo de esta patología con la comparación de la efectividad del manejo médico y quirúrgico.  Métodos:  a través de las búsquedas en diferentes bases de datos de manera sistemática se llevó a cabo una recopilación y síntesis por medio del método PRISMA para aquellos estudios que evalúan una intervención terapéutica, descartamos aquellos que no hacen alguna referencia a la validación de una estrategia terapéutica para la mordedura de una araña por el género Loxosceles.  Resultados:  diecinueve estudios, entre ellos seis ensayos clínicos aleatorizados, tres ensayos clínicos no aleatorizados, dos cohortes, dos revisiones sistemáticas y seis series de casos. En áreas de necrosis mayores a 1 cm la extirpación quirúrgica dentro de la primera semana a 10 días después de la mordedura es lo ideal, con mayores complicaciones descritas en un periodo menor a 48 horas, se debe aplicar un protocolo con fasciotomías descompresivas, necrosectomías y posteriores coberturas con colgajos e injertos para la prevención de síndromes compartimentales. El pretratamiento con dapsona por 14 días redujo la incidencia de complicaciones de la herida quirúrgica, al compararla con clorfenamina. El oxígeno hiperbárico (HBO) a 2.5 atmosferas reduce significativamente el diámetro de la herida a los 10 días, incluso dos a tres meses después del fracaso de otros tratamientos; sin embargo, no difiriere significativamente con respecto al tamaño de la lesión en comparación con otros tratamientos. El suero antiloxosceles reporta menor probabilidad de desarrollar necrosis y resolución en 97% de los casos.  Conclusiones:  parece existir un periodo en el que el abordaje quirúrgico resulta benéfico en los pacientes y éste se encuentra después de las primeras 48 horas y antes de las 10 semanas. La terapia médica parece tener mayor evidencia al uso de la dapsona y el suero antiloxosceles para evitar la progresión de las lesiones cutáneas, de forma general existen pocos estudios contundentes que permitan establecer indicaciones terapéuticas.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract:  Background and objective:  conducting a systematic review about the treatment of cutaneous loxoscelism to analyze the effectiveness of current therapies in comparison with the effectiveness of medical and surgical treatment.  Methods:  through a systematic search in different databases, a compilation and synthesis of papers was carried out by the PRISMA method for those studies that evaluate a surgical intervention, discarding the ones that don&#8217;t reference the validation of a therapeutic strategy for Loxosceles spiders&#8217; bites.  Results:  19 studies were included in this review, 6 randomized clinical essays, 3 non-randomized clinical essays, 2 cohorts, 2 systematic reviews and 6 case series. Regarding surgical treatment, it is described that, in necrotic areas larger than 1 centimeter, the early removal of the lesions within the first week and 10 days after a bite is ideal; nonetheless, when more complications are described in a period &lt; 48 hours, a protocol with decompressive fasciotomies must be applied, followed by necrosectomy and subsequent coverage with flaps and grafts for the prevention of compartmental syndromes. A pretreatment with dapsone for 14 days reduces the incidence of complications of the surgical wound. Clinical essays of dapsone regimes show more efficiency compared to the use of chlorpheniramine for the controlling the skin lesion, the use of hyperbaric oxygen (HBO) at 2.5 atmospheres significantly reduces the diameter of the wound in 10 days, even 2 to 3 months after the failure of other treatments; however, comparisons between dapsone, HBO, cyproheptadine, or a combination of these groups, show no significant differences on lesion size, the cohorts and clinical essays for antiloxosceles treatment describe a reduced probability of developing necrosis, paired with resolution in 97% of the cases.  Conclusions:  a surgical approach seems beneficial on patients during the first 48 hours, and before the 10 weeks mark. There seems to be more evidence for medical therapy than it exists for the use of dapsone and antiloxoceles serum to prevent the progression of skin lesions, but generally there are few conclusive studies that allow to establish therapeutic indications.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[loxoscelismo]]></kwd>
<kwd lng="es"><![CDATA[loxosceles]]></kwd>
<kwd lng="es"><![CDATA[araña reclusa marrón]]></kwd>
<kwd lng="es"><![CDATA[tratamiento]]></kwd>
<kwd lng="es"><![CDATA[revisión sistemática]]></kwd>
<kwd lng="en"><![CDATA[loxoscelism]]></kwd>
<kwd lng="en"><![CDATA[loxosceles]]></kwd>
<kwd lng="en"><![CDATA[brown recluse spider]]></kwd>
<kwd lng="en"><![CDATA[treatment]]></kwd>
<kwd lng="en"><![CDATA[systematic revision]]></kwd>
</kwd-group>
</article-meta>
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