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Logan J, Scott G, Peake C, Watson JJ, Jose R. Topical Negative Pressure Wound Dressing and Its Applications in the Hand—A Review of the Literature. J Hand Microsurg 2021; 14:276-283. [DOI: 10.1055/s-0041-1729467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
AbstractThe use of topical negative pressure wound therapy (NPWT) has become increasingly popular in the management of complex wounds. There are many theories as to the mechanism of action of NPWT, but the essential components of the various systems remain consistent. There are many attractive potential properties of negative pressure dressings that lend themselves to the management of upper limb injuries. This article explores the technique of negative pressure wound dressing, the theories pertaining to mechanism of action, and the increasingly broad indications described for the use of NPWT in the hand. The literature pertaining to the efficacy of NPWT in general is also discussed.
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Affiliation(s)
- James Logan
- Department of Trauma and Orthopedics, Royal Surrey County Hospital, Guildford, United Kingdom
| | - Georgia Scott
- Department of Trauma and Orthopedics, Royal Surrey County Hospital, Guildford, United Kingdom
| | - Christopher Peake
- Department of Trauma and Orthopedics, Royal Surrey County Hospital, Guildford, United Kingdom
| | - Jay James Watson
- Department of Trauma and Orthopedics, Royal Surrey County Hospital, Guildford, United Kingdom
| | - Rajive Jose
- Department of Hand Surgery, Queen Elizabeth Hospital, Birmingham, United Kingdom
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2
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Woo SH. Practical Tips to Improve Efficiency and Success in Upper Limb Replantation. Plast Reconstr Surg 2020; 144:878e-911e. [PMID: 31688770 DOI: 10.1097/prs.0000000000006134] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
LEARNING OBJECTIVES After reading this article, participant should be able to: 1. Describe the technique of replantation for very distal amputation of the digit and salvage procedures for venous drainage. 2. Perform single-digit replantation after viewing the videos. 3. Recognize appropriate cases for joint salvage techniques in periarticular amputation at each joint of the digit and wrist. 4. Outline the methods of flexor and extensor tendon reconstruction in an avulsed amputation of the digit or thumb. 5. Understand the order of digital replantation and transpositional replantation for a restoration of pinch or grip in multiple-digit amputation. SUMMARY This article provides practical tips and caveats for the latest replantation surgical techniques for digit, hand, and upper extremity amputation. Four videos, clinical photographs, and drawings highlight important points of operative technique and outcomes of replantation.
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Affiliation(s)
- Sang Hyun Woo
- From the W Institute for Hand and Reconstructive Microsurgery and the Department of Plastic and Reconstructive Surgery, W General Hospital
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Green T, Kavros S, Springer S, Drez D, McCabe M, Gremillion J. Team Approach: Complex Dermal Wound-Healing Utilizing Negative-Pressure Wound Therapy (NPWT) in Orthopaedic Trauma. JBJS Rev 2019; 6:e1. [PMID: 29509555 DOI: 10.2106/jbjs.rvw.17.00042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Tyson Green
- Imperial Health Center for Orthopaedics, Lake Charles, Louisiana
| | | | - Steve Springer
- Imperial Health Center for Orthopaedics, Lake Charles, Louisiana
| | - David Drez
- Imperial Health Center for Orthopaedics, Lake Charles, Louisiana
| | - Matthew McCabe
- Imperial Health Center for Orthopaedics, Lake Charles, Louisiana
| | - Jared Gremillion
- Imperial Health Center for Orthopaedics, Lake Charles, Louisiana
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Shine J, Efanov JI, Paek L, Coeugniet É, Danino MA, Izadpanah A. Negative pressure wound therapy as a definitive treatment for upper extremity wound defects: A systematic review. Int Wound J 2019; 16:960-967. [PMID: 30950218 DOI: 10.1111/iwj.13128] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 03/18/2019] [Accepted: 03/19/2019] [Indexed: 12/14/2022] Open
Abstract
Negative pressure wound therapy (NPWT) represents one of the many solutions for complex wounds of the upper extremity. The goal of this study was to investigate the most common indications for definitive treatment of wound defects in the upper extremity with NPWT and to report revision surgery outcomes after its use. A systematic review of the literature was performed. The following keywords and their combinations were used: "upper extremity," "arm," "forearm," "wrist," "hand," "finger" AND "negative-pressure wound therapy," "VAC therapy," "vacuum assisted closure." A total of 45 articles were included, regrouping 404 cases of NPWT in the upper extremity. The forearm was involved in 53% of cases, followed by hand (36%), fingers (10%), and arm (1%). Seventeen different indications were cited, the most common of which were radial forearm flap reconstruction (23%), burn wounds (18%), and compartment syndromes (17%). Of the cases, 90% did not require any subsequent surgical procedure, as opposed to 6% considered partial failures requiring minor revisions and 4% total failures requiring major revisions. Closure of radial forearm flap donor site required the most revision procedures when treated with NPWT. NPWT can be used for several indications pertaining to the reconstruction of the upper extremity. Positive outcomes as a definitive treatment are demonstrated in this systematic review, which reaffirms NPWT as a potent tool for reconstructive endeavours.
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Affiliation(s)
- Julien Shine
- Plastic and Reconstructive Surgery Service, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Johnny I Efanov
- Plastic and Reconstructive Surgery Service, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Laurence Paek
- Plastic and Reconstructive Surgery Service, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Édouard Coeugniet
- Plastic and Reconstructive Surgery Service, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Michel A Danino
- Plastic and Reconstructive Surgery Service, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Ali Izadpanah
- Plastic and Reconstructive Surgery Service, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
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Comparison of Negative Pressure Wound Therapy and Conventional Therapy for Cranial Bone-exposed Wounds in Rabbits. Ann Plast Surg 2017; 79:397-403. [DOI: 10.1097/sap.0000000000001074] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Dadaci M, Isci ET, Ince B, Altuntas Z, Evrenos MK, Uzun H, Sönmez E, Bitik O. Negative pressure wound therapy in the early period after hand and forearm replantation, is it safe? J Wound Care 2016; 25:350-5. [DOI: 10.12968/jowc.2016.25.6.350] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- M. Dadaci
- Necmettin Erbakan University, Meram Faculty of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery, Konya, Turkey
| | - E. T. Isci
- Acıbadem Healty Group Private Aile Hospital, Clinic of Plastic, Reconstructive and Aesthetic Surgery, Istanbul, Turkey
| | - B. Ince
- Necmettin Erbakan University, Meram Faculty of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery, Konya, Turkey
| | - Z. Altuntas
- Necmettin Erbakan University, Meram Faculty of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery, Konya, Turkey
| | - M. K. Evrenos
- Celal Bayar University, Faculty of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery, Manisa, Turkey
| | - H. Uzun
- Hacettepe University, Faculty of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery, Ankara, Turkey
| | - E. Sönmez
- Katip Celebi University, Ataturk State Hospital, Department of Plastic, Reconstructive and Aesthetic Surgery, Izmir, Turkey
| | - O. Bitik
- Hacettepe University, Faculty of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery, Ankara, Turkey
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Ma Z, Shou K, Li Z, Jian C, Qi B, Yu A. Negative pressure wound therapy promotes vessel destabilization and maturation at various stages of wound healing and thus influences wound prognosis. Exp Ther Med 2016; 11:1307-1317. [PMID: 27073441 PMCID: PMC4812564 DOI: 10.3892/etm.2016.3083] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 01/20/2016] [Indexed: 12/14/2022] Open
Abstract
Negative pressure wound therapy (NPWT) has been observed to accelerate the wound healing process in humans through promoting angiogenesis. However, the potential biological effect and relevant molecular mechanisms, including microvessel destabilization, regression and endothelial cell proliferation in the early stage (1–3 days), and the neovascular stabilization and maturation in the later stage (7–15 days), have yet to be fully elucidated. The current study aimed to research the potential effect of NPWT on angiogenesis and vessel maturation, and investigate relevant association between mature microvessels and wound prognosis, as well as the regulatory mechanisms in human wound healing. Patients in the present study (n=48) were treated with NPWT or a petrolatum gauze, and relevant growth factors and vessel changes were detected using various experimental methods. NPWT increased the expression levels of angiogenin-2 (Ang-2), and decreased the expression levels of Ang-1 and ratios of Ang-1/Ang-2 in the initial stages of wound healing. However, in the latter stages of wound healing, NPWT increased the expression levels of Ang-1 and ratios of Ang-1/Ang-2, as well as the phosphorylation level of tyrosine kinase receptor-2. Consequently, microvessel pericyte coverage was gradually elevated, and the basement membrane was gradually supplied with new blood at the later stage of wound healing. In conclusion, NPWT may preferentially stimulate microvessel destabilization and regression in the early stage of wound healing, and as a consequence, increase angiogenesis. Subsequently, in the later stage of wound healing, NPWT may preferentially promote microvessel stabilization, thereby promoting microvessel maturation in human wounds through the angiogenin/tyrosine kinase receptor-2 signaling pathway. The results of the present study results demonstrated that NPWT was able to accelerate wound healing speed, and thus influence wound prognosis, as a result of an abundance of mature microvessels in human wounds.
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Affiliation(s)
- Zhanjun Ma
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Kangquan Shou
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Zonghuan Li
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Chao Jian
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Baiwen Qi
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Aixi Yu
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
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Fernandez-Alvarez JA, Barrera-Pulido F, Lagares-Borrego A, Narros-Gimenez R, Gacto-Sanchez P, Gomez-Cia T. Coverage of supraumbilical abdominal wall defects: The tunnelled-pedicled ALT technique. Microsurgery 2015; 37:119-127. [PMID: 26109324 DOI: 10.1002/micr.22437] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 05/08/2015] [Accepted: 05/19/2015] [Indexed: 11/11/2022]
Abstract
Abdominal wall defects are a challenge for reconstructive surgeons. Although the utility of anterolateral thigh perforator (ALT) flap has been well established for lower abdominal wall reconstruction, pedicled ALT flap is usually not considered for supraumbilical defects in the most recent algorithms. The purpose of this paper is to report the results of a tunneled pedicled ALT flap for reconstruction of supraumbilical defect from a series of patients. From July 2009 to September2014, six patients underwent delayed abdominal wall coverage using pedicled ALT flaps and reinforcement with polypropylene meshes. Defects occurred after surgical complications and abdominal trauma. Flaps were tunneled beneath the rectus femoris and sartorius muscles to increase the pedicle length. The size of the skin islands ranged from 22-29 × 10-14 cm. All flaps survived and the healing of the wounds was successful. Partial dehiscence of donor site occurred in one patient, and small wound dehiscence due to minimal distal necrosis was observed in another patient. No functional problems were reported in donor site, and no complications occurred in 6-68 months of follow-up. The tunneled pedicled ALT flap may provide a reliable alternative method for abdominal wall reconstruction, including supraumbilical defects. © 2015 Wiley Periodicals, Inc. Microsurgery 37:119-127, 2017.
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Affiliation(s)
| | - Fernando Barrera-Pulido
- Department of Plastic and Reconstructive Surgery, Virgen Del Rocio University Hospital, Seville, Spain
| | - Araceli Lagares-Borrego
- Department of Plastic and Reconstructive Surgery, Virgen Del Rocio University Hospital, Seville, Spain
| | - Rocio Narros-Gimenez
- Department of Plastic and Reconstructive Surgery, Virgen Del Rocio University Hospital, Seville, Spain
| | | | - Tomas Gomez-Cia
- Department of Plastic and Reconstructive Surgery, Virgen Del Rocio University Hospital, Seville, Spain
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Hwang KT, Kim SW, Sung IH, Kim JT, Kim YH. Is delayed reconstruction using the latissimus dorsi free flap a worthy option in the management of open IIIB tibial fractures? Microsurgery 2015; 36:453-9. [PMID: 25976771 DOI: 10.1002/micr.22428] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 03/17/2015] [Accepted: 04/14/2015] [Indexed: 01/27/2023]
Abstract
Early reconstruction of severe open fractures, performed within 7 days of the injury, has a better outcome than closure after 7 days. However, the uncertain demarcation of damaged tissue often results in delayed reconstruction. In this article, we report our surgical outcomes of delayed reconstruction using latissimus dorsi free flap with internal fixation. Twenty-three patients with Gustilo type IIIB open tibial fractures Between March 2009 and May 2012 were included in this study. There were 16 cases of distal 1/3 fracture of the tibia, 4 of midshaft fracture, 1 of proximal 1/3 fracture, and 2 of segmental fracture. Serial debridement with application of negative pressure wound therapy (NPWT) was performed before the final operation. All patients underwent internal fixation of the bone and reconstruction of soft tissue defect using latissimus dorsi free flap. The number of serial debridements, excluding those performed during emergency and finial operation, ranged from 1 to 5 (mean 2.69) times. Mean time from injury to final operation was 10.65 (range, 7-22) days. All flaps survived without complications. Three cases (13%) were infected, and three cases required further bone graft surgery to facilitate bone union (13%). Bone union was achieved after a mean 6.3 (range, 3-12) months. Mean follow-up period was 16.34 (range, 12-26) months. During follow-up, all patients were able to ambulate without use of an aid. In cases of severe open fracture, treatment should emphasize soft tissue coverage rather than rushing to achieve definitive fixation in the setting of poor surrounding tissues. When delayed reconstruction is inevitable, radical debridement is performed first, then NPWT is used as bridging therapy, and free flap could be considered for definite soft tissues coverage. © 2015 Wiley Periodicals, Inc. Microsurgery 36:453-459, 2016.
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Affiliation(s)
- Kyu Tae Hwang
- Department of Orthopedic Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Sang Wha Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University, College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Il Hoon Sung
- Department of Orthopedic Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Jeong Tae Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Youn Hwan Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, Seoul, Korea.
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Kim SW, Youn DG, Hwang KT, Kim JT, Kim YH. Reconstruction of severely infected gluteal osteoradionecrosis using negative-pressure wound therapy and latissimus dorsi musculocutaneous flaps. Microsurgery 2015; 36:29-36. [PMID: 25641653 DOI: 10.1002/micr.22370] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 12/07/2014] [Accepted: 12/11/2014] [Indexed: 11/08/2022]
Abstract
Radiotherapy is mandatory for aggressive cancer treatment. Unfortunately, the high-energy radiation used can lead to severe osteoradionecrosis. Radical debridement of devitalized bone and soft tissue coupled with reconstruction using well-vascularized tissues is the accepted treatment for this condition. However, osteoradionecrosis cannot be controlled easily or rapidly. The aim of this study was to present the results of the use of serial negative-pressure wound therapy (NPWT) in combination with a latissimus dorsi myocutaneous flap for treatment of gluteal osteoradionecrosis in a consecutive series of patients. Between January 2003 and December 2012, nine patients underwent reconstruction using serial NPWT and latissimus dorsi myocutaneous flaps. We applied negative-pressure dressings for at least 8 weeks. Final reconstruction was performed after the infection was controlled. The superior gluteal artery and vein were used as recipient vessels in all the cases. The mean interval between operation and radiation therapy was 28.3 ± 8.3 years, and the mean number of debridement performed was 6.3 ± 1. NPWT dressings were applied for 8-12 weeks (mean, 9.3 ± 2 weeks). The defects ranged in size from 14 × 8 cm to 18 × 15 cm. The flap size ranged from 15 × 10 cm to 18 × 15 cm. All flaps survived uneventfully except in one patient who experienced chronic seroma and wound dehiscence. There were no recurrences of osteomyelitis during the follow-up periods (mean, 14 ± 6.1 months). Based on the results obtained from this consecutive series of patients, we suggest that this methodology may provide an alternative approach for the treatment of severe osteoradionecrosis of the gluteal region.
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Affiliation(s)
- Sang Wha Kim
- Department of Plastic and Reconstructive Surgery, The Catholic University of Korea, Seoul, South Korea
| | - Dong Geun Youn
- Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, Seoul, South Korea
| | - Kyu Tae Hwang
- Department of Orthopedic Surgery, College of Medicine, Hanyang University, Seoul, South Korea
| | - Jeong Tae Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, Seoul, South Korea
| | - Youn Hwan Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, Seoul, South Korea
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Topkara A, Ozkan A, Ozcan RH. The treatment of tissue defects related to the compartment syndrome occurring in the fibula osteocutaneous free flap donor area with vacuum assisted closure therapy. Microsurgery 2014; 35:417-8. [PMID: 25382650 DOI: 10.1002/micr.22351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 10/01/2014] [Accepted: 10/24/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Adem Topkara
- Department of Plastic and Reconstructive Surgery, Pamukkale University Hospital, Pamukkale, Denizli, Turkey
| | - Adem Ozkan
- Department of Plastic and Reconstructive Surgery, Pamukkale University Hospital, Pamukkale, Denizli, Turkey
| | - Ramazan Hakan Ozcan
- Department of Plastic and Reconstructive Surgery, Pamukkale University Hospital, Pamukkale, Denizli, Turkey
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Dadaci M, Ince B, Arslan A. Comments on “Vacuum assisted closure therapy for treatment of complex wounds in replanted extremities”. Microsurgery 2014; 34:503-4. [DOI: 10.1002/micr.22282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 05/07/2014] [Accepted: 05/21/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Mehmet Dadaci
- Department of Plastic; Reconstructive; and Aesthetic Surgery; Necmettin Erbakan University, Faculty of Meram Medicine; Konya Turkey
| | - Bilsev Ince
- Department of Plastic; Reconstructive; and Aesthetic Surgery; Necmettin Erbakan University, Faculty of Meram Medicine; Konya Turkey
| | - Abdullah Arslan
- Department of Underwater and Hyperbaric Medicine; Necmettin Erbakan University, Faculty of Meram Medicine; Konya, Turkey
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