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Peng C, Yang F, Yu J, Peng L, Zhang C, Chen C, Lin Z, Li Y, He J, Jin Z. Machine Learning Prediction Algorithm for In-Hospital Mortality following Body Contouring. Plast Reconstr Surg 2023; 152:1103e-1113e. [PMID: 36940163 DOI: 10.1097/prs.0000000000010436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
BACKGROUND Body contouring is a common procedure, but it is worth attention because of concern for a variety of complications, and even the potential for death. As a result, the purpose of this study was to determine the key predictors following body contouring and create models for the risk of mortality using diverse machine learning (ML) models. METHODS The National Inpatient Sample database from 2015 to 2017 was queried to identify patients undergoing body contouring. Candidate predictors, such as demographics, comorbidities, personal history, postoperative complications, and operative features, were included. The outcome was in-hospital mortality. Models were compared by area under the curve, accuracy, sensitivity, specificity, positive and negative predictive values, and decision curve analysis. RESULTS Overall, 8214 patients undergoing body contouring were identified, among whom 141 (1.72%) died in the hospital. Variable importance plot demonstrated that sepsis was the variable with greatest importance across all ML algorithms, followed by Elixhauser Comorbidity Index, cardiac arrest, and so forth. The naive Bayes model had a higher predictive performance (area under the curve, 0.898; 95% CI, 0.884 to 0.911) among these eight ML models. Similarly, in the decision curve analysis, the naive Bayes model also demonstrated a higher net benefit (ie, the correct classification of in-hospital deaths considering a tradeoff between false-negatives and false-positives) compared with the other seven models across a range of threshold probability values. CONCLUSION The ML models, as indicated by this study, can be used to predict in-hospital death for patients at risk who undergo body contouring.
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Affiliation(s)
- Chi Peng
- From the Department of Health Statistics, Second Military Medical University
| | - Fan Yang
- Departments of Plastic Surgery and Burns
| | - Jian Yu
- From the Department of Health Statistics, Second Military Medical University
| | - Liwei Peng
- Neurosurgery, Tangdu Hospital, Fourth Military Medical University
| | - Chenxu Zhang
- From the Department of Health Statistics, Second Military Medical University
| | - Chenxin Chen
- From the Department of Health Statistics, Second Military Medical University
| | - Zhen Lin
- From the Department of Health Statistics, Second Military Medical University
| | - Yuejun Li
- Departments of Plastic Surgery and Burns
| | - Jia He
- From the Department of Health Statistics, Second Military Medical University
| | - Zhichao Jin
- From the Department of Health Statistics, Second Military Medical University
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Villegas-Alzate F, Caycedo-García DJ, Malaver-Acero R, Hidalgo-Ibarra SA, Cardona VA, Villegas-Mesa JD. TULUA: Effects of Flap Undermining and Type of Wall Plicature in a Rat Model Abdominoplasty. Aesthetic Plast Surg 2022; 46:456-467. [PMID: 34424368 DOI: 10.1007/s00266-021-02501-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/22/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND TULUA, a transverse plication lipoabdominoplasty, which excludes elevation of the supraumbilical flap and includes a skin graft neoumbilicoplasty, claims greater safety and better results. An animal study was designed to compare it, with two current techniques. MATERIALS AND METHODS Three matched groups of 12 rats had combined liposuction and abdominoplasty. Liposuction was extensive and unrestricted. Groups 1 and 2 had vertical plication and transposition umbilicoplasty, and group 3 had transverse plication and neoumbilicoplasty. Flap elevation in the epigastrium was wide to costal margins in group 1, limited to a tunnel in group 2, and no dissection in group 3. The animals were observed for 21 days and then euthanized. Intraoperative, postoperative, and postmortem variables and findings were measured and analyzed to find differences between groups. RESULTS Transverse lipoabdominoplasty demonstrated a wider wall plication area, as well as a decrease in tension to close the wound, causing the horizontal scar to remain in a low position. In vertical plication lipoabdominoplasty groups, flap necrosis and seromas were more frequent, and the umbilical position descended due to secondary healing and scar contraction. The scar's scores were better in the transverse group and were confirmed when evaluated by external observers.In postmortem examination, horizontal plication presented less widening; perforator vessels were preserved when surgical undermining of the upper abdomen was not performed, and there were fewer seromas. CONCLUSION In a rat model, TULUA demonstrates superior results and a decrease in complications when compared to lipoabdominoplasties with vertical plication and wide or tunneled dissection in the upper abdomen. NO LEVEL ASSIGNED This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Francisco Villegas-Alzate
- Departamento de cirugía plástica, Facultad de Salud, Universidad del Valle, Calle 4B N°36-00, Cali, Colombia.
| | - Diego José Caycedo-García
- Jefe de servicio de cirugía plástica, Universidad del Valle, 3 piso hospital universitario del Valle, Cali, Colombia
| | - Ricardo Malaver-Acero
- Facultad de medicina veterinaria y zootecnia, Universidad San Martin Cali Colombia, Carrera 122 #23-395 del, Vía Cali - Puerto Tejada, Cali, Cauca, Colombia
| | | | | | - José Daniel Villegas-Mesa
- Escuela de Ciencias de la Salud, Universidad Pontificia Bolivariana, Calle 78b No 72a-109, Medellín, Colombia
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Safety Comparison of Abdominoplasty and Brazilian Butt Lift: What the Literature Tells Us. Plast Reconstr Surg 2021; 148:1270-1277. [PMID: 34847113 DOI: 10.1097/prs.0000000000008599] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although abdominoplasty is a mainstay of the plastic surgeon, the safety of the Brazilian butt lift (BBL) has been questioned, effectively being prohibited in some countries. The central rationale for the safety concern over the BBL stems from a publication stating a mortality rate of one in 3000. The question remains: What is the real safety of these procedures? METHODS Focusing on mortality, literature searches were performed for BBL and for abdominoplasty. The 2017 Aesthetic Surgery Education and Research Foundation survey data and publication were examined and analyzed. Additional data from the American Association for Accreditation of Ambulatory Surgical Facilities were obtained independently. RESULTS Abdominoplasty and BBL appear to have similar safety based on mortality; however, the nature of their mortalities is different. Although most abdominoplasty deaths are secondary to deep venous thrombosis/pulmonary embolism-inherent circulatory thrombotic abnormality-BBL mortality is associated with iatrogenic pulmonary fat embolism. BBL mortality rates from more recent surveys on BBL safety demonstrate a mortality of one in 15,000. CONCLUSIONS Although deep venous thrombosis/pulmonary embolism will always remain an abdominoplasty risk, intraoperative BBL pulmonary fat embolism has the potential to be reduced dramatically with a better understanding of dynamic anatomy, surgical instrumentation, and technique. The authors are now presented with a better lens with which to view a more accurate safety profile of BBL surgery, including its place among other commonly performed aesthetic procedures.
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Surgical Management of Chronic Encapsulated Abdominal Wall Seroma 8 Years after Abdominoplasty. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3697. [PMID: 34422519 PMCID: PMC8376326 DOI: 10.1097/gox.0000000000003697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 05/20/2021] [Indexed: 11/26/2022]
Abstract
Seroma is a common complication of body-contouring surgery. Current literature focuses on prevention or initial management of seroma formation; however, no definitive evidence exists to guide management of chronic or recurrent seromas. We describe a case of a recurrent abdominal wall seroma following abdominoplasty. The seroma was present for 8 years despite employing multiple treatment modalities. After presentation to our clinic, the patient was taken to the operating room, where the seroma pseudocapsule was excised, progressive tension sutures were utilized, and drains were placed. To date, there has been no recurrence of the seroma. We propose that chronicity, recurrence, and persistence of seroma are indications for surgical intervention.
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Following ISAPS Recommendations, Does it Really Help? Aesthetic Plast Surg 2021; 45:1888-1894. [PMID: 33598743 DOI: 10.1007/s00266-021-02174-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 02/03/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND The demand for abdominoplasty procedures has increased in surgical centres as a result of patient preference and economic concerns. The International Society of Aesthetic Plastic Surgery (ISAPS) published the Facility Accreditation Guideline on 22 October 2018. It is a list of recommendations that aim to reduce the incidence of complications and increase safety standards. OBJECTIVES The objective of this work was to detect the effects of the ISAPS guidelines on the morbidity associated with abdominoplasty procedures in day care surgical centres. METHODS The authors performed a retrospective study. Data regarding complications of abdominoplasty were collected from medical records of the last 350 cases of abdominoplasty performed in December 2018. The complications and their incidences were compared with similar previously published data of abdominoplasty operations performed by other authors and in surgical centres before initiation of the ISAPS Facility Accreditation Guideline. RESULTS In all cases, we achieved a significant reduction in skin and adipose tissue with improvement in body shape. The incidence of major and minor post-operative complications was lower than that reported in other literature. CONCLUSIONS This report shows that abdominoplasty is a safe procedure with low complication rates, which are even lower when the ISAPS Facility Accreditation Guideline is followed together with national, regional, state and other legal requirements. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Rosen AD, Gutowski KA, Hartman T. Reduced Seroma Risk in Drainless Abdominoplasty Using Running Barbed Sutures: A 10-Year, Multicenter Retrospective Analysis. Aesthet Surg J 2020; 40:531-537. [PMID: 31504169 DOI: 10.1093/asj/sjz238] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Drains are still commonly inserted during abdominoplasties despite extensive evidence documenting the benefits of drainless procedures. Continued improvements in progressive tension suturing (PTS) techniques and suture technologies have consistently shown a reduced seroma risk profile that outperforms procedures involving surgical drains. OBJECTIVES The aim of this report was to assess the authors' combined patient series, which represents the largest and longest-running, retrospective, multicenter set of abdominoplasty patients treated with a PTS technique involving running barbed sutures. METHODS Two surgical groups, each at different surgical centers, have for the past decade performed drainless abdominoplasties in which running barbed sutures were used. The results for all 445 patients in this series are reported by surgical center and pooled across centers. RESULTS The majority of the 445 patients underwent drainless abdominoplasty alone (n = 368; 82.7%); most of the remaining patients did so as part of a circumferential body lift (n = 55; 12.4%). Overall, 33 (7.4%) patients experienced a postoperative complication. The overall seroma rate was 4.7% (21 of 445 patients), but this dropped to 2.3% after surgical technique modifications were made to decrease upper abdominal dead space. The seroma incidence in this series is markedly lower than the 13% seroma rate with drains reported during the same time period and comparable to those seen in drainless abdominoplasties with interrupted suture techniques. CONCLUSIONS Drainless abdominoplasty involving PTS with running barbed sutures shows long-term reproducibility in lowering seroma risk compared to techniques in which drains are inserted, supporting results from published series of drainless abdominoplasty procedures that use interrupted suture techniques. LEVEL OF EVIDENCE: 4
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Suh YC, Oh TM, Lee YH, Kim EK, Han HH, Eom JS. Effects of hydrochlorothiazide on drainage volume and seroma formation in deep inferior epigastric perforator flap breast reconstruction: Randomized controlled trial. J Plast Reconstr Aesthet Surg 2019; 73:663-672. [PMID: 31843386 DOI: 10.1016/j.bjps.2019.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 10/15/2019] [Accepted: 11/22/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Seroma is a recognized complication encountered at the reconstructed breast and donor site after abdominal-based breast reconstruction. Seroma is caused by lymphatic channel disruption and the formation of a large space between the deep fascia during flap elevation. Surgical techniques to preserve the lymphatics and secure the closure of the donor site can reduce seroma formation. This study investigated the safety and effectiveness of the diuretic hydrochlorothiazide at reducing interstitial fluid accumulation and seroma formation during deep inferior epigastric perforator (DIEP) flap breast reconstruction. METHODS Sixty patients with breast cancer who underwent skin- or nipple-sparing mastectomy and DIEP flap reconstruction were enrolled between August 2016 and June 2017. The patients were randomly assigned to receive either 25 mg per day of hydrochlorothiazide from the second to the twentieth day after surgery (treatment) or no diuretic (control). The clinicopathological characteristics, drainage time, and drainage volume were statistically compared between the two groups. RESULTS The average total drainage volume at the donor site was 291 mL in the treatment group and 434 mL in the control group (p = 0.003). The differences in body mass index and flap weight between the two groups were not statistically significant (p = 0.879 and p = 0.963, respectively). No hypotension or electrolyte imbalance was noted during the follow-up. CONCLUSIONS Intake of 25 mg per day of hydrochlorothiazide tablets effectively reduced the total abdominal drainage volume and removal time of indwelling drains. However, the adverse effects should be further investigated in a large population and multiracial cohort before using hydrochlorothiazide for seroma prevention.
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Affiliation(s)
- Y C Suh
- Department of Plastic Surgery, Bucheon St. Mary's Hospital, The Catholic University of Korea, College of Medicine, 327, Sosa-ro, Bucheon-si, Gyeonggi-do, Republic of Korea
| | - T M Oh
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea
| | - Y H Lee
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea
| | - E K Kim
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea
| | - H H Han
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea
| | - J S Eom
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea.
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Goldman A, Wollina U, França K, Tchernev G, Lotti T. Chronic Encapsulated Seroma Persisting for Three Years after Abdominoplasty and a Successful Surgical Solution. Open Access Maced J Med Sci 2018; 6:82-84. [PMID: 29483991 PMCID: PMC5816325 DOI: 10.3889/oamjms.2018.051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 11/29/2017] [Accepted: 11/30/2017] [Indexed: 12/03/2022] Open
Abstract
Abdominoplasty is listed among five most common esthetic surgical procedures in the Western World. Despite all efforts, abdominoplasty bears a high risk of complications. We observed a 39-year-old-woman with previous classical abdominoplasty performed elsewhere three years ago. Clinical examination demonstrated a swollen and tense abdominal mass. Laboratory findings were normal. Clinical examination was completed by abdominal ultrasonography which demonstrated both, a significant fluid volume in this area and a dense fibrous “capsule”. The diagnosis was a late or chronic encapsulated seroma with a thick pseudocapsule or “bursa”. We performed a revision abdominoplasty with a standard supra-fascial dissection. Surgical resection of infra-umbilical flap containing skin, subcutaneous tissue and capsulectomy were performed under general anaesthesia. A new umbilicus was created attaching small skin flaps in the muscular fascia. No drains were used. We observed no seroma formation. Follow up after six and ten months was unremarkable. The fibrous pseudocapsule of chronic seroma results in different degrees of deformities, abdominal scar deviation and asymmetry. Surgical capsulectomy combined with revision abdominoplasty with preservation of Scarpa’s fascia and placement of progressive tension sutures resulted in being effective and leads an esthetic outcome without seroma recurrence.
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Affiliation(s)
- Alberto Goldman
- Clinica Goldman - Plastic Surgery Av. Augusto Meyer 163 conj.1203, Porto Alegre/RS, Brazil
| | - Uwe Wollina
- Stadtisches Klinikum Dresden - Department of Dermatology and Allergology, Dresden, Sachsen, Germany
| | - Katlein França
- University of Miami School of Medicine 1400 NW 10th Avenue, Miami, Florida 33136-1015, United States
| | - Georgi Tchernev
- Department of Dermatology, Venereology and Dermatologic Surgery, Medical Institute of Ministry of Interior, Sofia, Bulgaria.,Onkoderma, Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria
| | - Torello Lotti
- University G. Marconi of Rome - Dermatology and Venereology, Rome, Italy
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Lymphocele Following Liposuction in the Thigh. Aesthetic Plast Surg 2017; 41:1408-1412. [PMID: 28664307 DOI: 10.1007/s00266-017-0930-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 06/21/2017] [Indexed: 10/19/2022]
Abstract
Lymphocele has not been reported as a complication after liposuction. In this study, we present the case of a patient who developed a cystic lesion after liposuction in her right thigh. The cyst could contract and evolve. The diagnosis of pseudobursa seroma (late seroma) was first considered. However, lymphoscintigraphy showed that lymphatic fluid accumulated in the cyst, and lymphatic vessel connected with it. The final diagnose was a lymphocele. After interventional therapy and conservative treatment failed, the lymphocele was resected. The subcutaneous soft tissue around the cyst was divided into bundles and then ligated with the purpose of blocking lymph leakage from the lymphatic duct. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Ardehali B, Fiorentino F. A Meta-Analysis of the Effects of Abdominoplasty Modifications on the Incidence of Postoperative Seroma. Aesthet Surg J 2017; 37:1136-1143. [PMID: 28482000 DOI: 10.1093/asj/sjx051] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Seroma is the most common complication of abdominoplasty. Certain modifications to abdominoplasty may reduce the risk of seroma. OBJECTIVES The authors evaluated the incidence of seroma for 3 abdominoplasty techniques: preservation of Scarpa's fascia, placement of progressive tension (or quilting) sutures, and application of fibrin glue. METHODS In this systematic review and meta-analysis, the Cochrane Library, MEDLINE, Embase, and the International Clinical Trials Registry Platform (World Health Organization) were searched to identify studies of patients who underwent abdominoplasty with seroma as a potential "outcome." RevMan 5.3 was utilized for data management, statistical analyses, and graph preparation. RESULTS Fifteen studies (1824 total patients) met the criteria for inclusion in this review. The overall risk of bias was high, mainly owing to the nonrandomized nature of most studies. Abdominoplasty with preservation of Scarpa's fascia or placement of progressive tension sutures was associated with a significantly reduced incidence of seroma compared with that of standard abdominoplasty (P < 0.0001 and P < 0.0002, respectively). Abdominoplasty with application of fibrin glue was similar to standard abdominoplasty in terms of seroma development. CONCLUSIONS Placement of progressive tension sutures or preservation of Scarpa's fascia during abdominoplasty may reduce the likelihood of postoperative seroma. Application of fibrin glue has no impact on seroma formation. LEVEL OF EVIDENCE 2.
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Affiliation(s)
- Ben Ardehali
- Dr Ardehali is a Consultant Plastic and Reconstructive Surgeon, St George’s Hospital NHS Foundation Trust, London, United Kingdom. Dr Fiorentino is a Statistician and Research Fellow, Imperial College Trial Unit and Department of Surgery, Imperial College, London, United Kingdom
| | - Francesca Fiorentino
- Dr Ardehali is a Consultant Plastic and Reconstructive Surgeon, St George’s Hospital NHS Foundation Trust, London, United Kingdom. Dr Fiorentino is a Statistician and Research Fellow, Imperial College Trial Unit and Department of Surgery, Imperial College, London, United Kingdom
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Managing Complications in Abdominoplasty: A Literature Review. Arch Plast Surg 2017; 44:457-468. [PMID: 28946731 PMCID: PMC5621815 DOI: 10.5999/aps.2017.44.5.457] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 06/01/2017] [Accepted: 06/13/2017] [Indexed: 11/08/2022] Open
Abstract
Background Abdominoplasty, with or without liposuction, is among the most frequently performed aesthetic procedures. Its main objective is to improve the body contour by means of excising redundant skin and fat tissue. Although abdominoplasty is considered a safe procedure with high satisfaction rates, intraoperative and postoperative complications can become a challenge for the surgical team. The aim of this article is to offer a synopsis of the most common complications arising after abdominoplasty, along with evidence-based guidelines about how to prevent and treat them. Methods A systematic MEDLINE search strategy was designed using appropriate Medical Subject Headings (MeSH) terms, and references were scanned for further relevant articles. Results According to the published case series, local complications are considerably more common than complications with systemic repercussions. Approximately 10% to 20% of patients suffer a local complication following abdominoplasty, while fewer than 1% suffer a systemic complication. Prevention and management strategies are critically discussed for complications including seroma, haematoma, infection, skin necrosis, suture extrusions, hypertrophic scars, neurological symptoms, umbilical anomalies, deep venous thrombosis and pulmonary thromboembolism, respiratory distress, and death. Conclusions The complications of abdominoplasty vary in severity and in the impact they have on the aesthetic outcomes. Recommendations for prevention and management are based on various levels of evidence, with a risk of observer bias. However, most complications can be treated appropriately following the current standards, with satisfactory results.
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Abdali H, Heydari M, Omranifard M, Rasti M. Classic high lateral tension and triangular resection methods to prevent dog ear and elongation scar in patients undergoing abdominoplasty: A comparative open-label clinical trial. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2017; 22:73. [PMID: 28717370 PMCID: PMC5508506 DOI: 10.4103/jrms.jrms_214_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 08/10/2016] [Accepted: 03/14/2017] [Indexed: 11/18/2022]
Abstract
Background: One of the most common operations in the plastic surgery curse is abdominoplasty. Several methods were recommended for achieving better results. In the present study, efficacy of a new method compared with classical high lateral tension on preventing dog ear and elongation scar was evaluated. Materials and Methods: in an open-label, randomized clinical trial, seventy patients who were candidates for abdominoplasty were selected and randomly divided into two groups. The first group was operated by classic high lateral method and the second group was operated by a new method concentrating on changing incision line and angle. Dog ear prevention, length of scar, improvement, and postoperative complications were compared between the two groups. Results: The mean ± standard deviation (SD) length of scar in treated patients with classical and new abdominoplasty surgical methods was 53.68 ± 6.34 and 41.71 ± 1.78 cm, respectively, and the length of scar in the group treated with the new method was significantly shorter (P < 0.001). The mean ± SD distance between two anterior superior iliac spine in group treated by new method was significantly decreased after surgery (31.3 ± 1.3 cm) compared to before intervention (36.7 ± 3.9 cm) (P < 0.01). Conclusion: The new method is more likely to be successful in patients with high lateral tension abdominoplasty. However, according to the lack of similar studies in this regard and the fact that this method was introduced for the first time, it is recommended that further studies in this area are needed and patients in term of complications after surgery need a longer period of follow-up.
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Affiliation(s)
- Hossein Abdali
- Craniofacial Anomalies and Cleft Palate Research Center, Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Plastic Surgery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammadbagher Heydari
- Department of Plastic Surgery, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Surgery, lmam Reza Hospital, Kermanshah University of Medical Science, Kermanshah, Iran
| | - Mahmood Omranifard
- Department of Plastic Surgery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahdi Rasti
- Department of Plastic Surgery, Isfahan University of Medical Sciences, Isfahan, Iran
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Jabbour S, Awaida C, Mhawej R, Bassilios Habre S, Nasr M. Does the Addition of Progressive Tension Sutures to Drains Reduce Seroma Incidence After Abdominoplasty? A Systematic Review and Meta-Analysis. Aesthet Surg J 2017; 37:440-447. [PMID: 27789426 DOI: 10.1093/asj/sjw130] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Progressive tension sutures (PTS) are commonly utilized to reduce postoperative seroma in abdominoplasty. However, current evidence regarding PTS in abdominoplasty is limited to small series and the findings of single institutions. OBJECTIVES The authors reviewed the available literature concerning the effects of PTS and drains on seroma formation following abdominoplasty, and summarized the different techniques that have been described to date. METHODS We conducted a systematic review of the Medline, Embase, and Cochrane databases. We identified randomized controlled trials (RCTs) and observational studies in which the numbers of patients who had postoperative seroma were indicated. We applied the Cochrane Collaboration's tool for assessing the risk of bias. RESULTS Seven studies were included (three RCTs and four retrospective studies). Patients who had PTS and drains following abdominoplasty had a significantly lower rate of postoperative seroma than those who had drains only. The mean surgical time difference between the two groups was 23 minutes. There was no difference in postoperative seroma rate in patients who had PTS and drains placed following abdominoplasty compared to those who had PTS only. CONCLUSIONS Addition of PTS to drains reduces the risk of postoperative seroma in standard abdominoplasty. More RCTs with larger sample sizes and better comparability are warranted to confirm with more confidence the impact of PTS in abdominoplasty. LEVEL OF EVIDENCE 2
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Affiliation(s)
- Samer Jabbour
- Department of Plastic and Reconstructive Surgery, Hotel Dieu de France Hospital, Beirut, Lebanon. Department of Otorhinolaryngology, Hotel Dieu de France Hospital, Beirut, Lebanon. Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Cyril Awaida
- Department of Plastic and Reconstructive Surgery, Hotel Dieu de France Hospital, Beirut, Lebanon. Department of Otorhinolaryngology, Hotel Dieu de France Hospital, Beirut, Lebanon. Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Rachad Mhawej
- Department of Plastic and Reconstructive Surgery, Hotel Dieu de France Hospital, Beirut, Lebanon. Department of Otorhinolaryngology, Hotel Dieu de France Hospital, Beirut, Lebanon. Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Samer Bassilios Habre
- Department of Plastic and Reconstructive Surgery, Hotel Dieu de France Hospital, Beirut, Lebanon. Department of Otorhinolaryngology, Hotel Dieu de France Hospital, Beirut, Lebanon. Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Marwan Nasr
- Department of Plastic and Reconstructive Surgery, Hotel Dieu de France Hospital, Beirut, Lebanon. Department of Otorhinolaryngology, Hotel Dieu de France Hospital, Beirut, Lebanon. Groupe Hospitalier Paris Saint-Joseph, Paris, France
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Kuthe A. Successful treatment of a chronic abdominal wall seroma with the polysaccharide 4DryField ® PH - A case report. Int J Surg Case Rep 2016; 27:48-50. [PMID: 27541060 PMCID: PMC4992008 DOI: 10.1016/j.ijscr.2016.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 08/07/2016] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Seroma formation is one of the most prevalent complications after liposuction, abdominoplasty, mastectomy or hernia repair. They can disappear without treatment, but also may persist and require complex therapy. This report describes how 4DryField® PH polysaccharide powder successfully was applied for chronic seroma therapy. PRESENTATION OF THE CASE An 80year old male patient presented with a persistent seroma (1000cm3 volume) resulting from liposuction about 15 years ago. In a first approach he was treated using en bloc excision without opening the capsule. Three month later the patient presented with a recurrent seroma of the same size. This time 1100cm3 bloody discolored fluid was aspirated. The skin was lifted using a redon tubing drawn through the whole length of the wound cavity. This allowed even distribution of 4DryField® PH powder (10g) within the former seroma cavity. Computed Tomography (CT) imaging after 4.5 month and sonographic examination after an additional year confirmed treatment success. DISCUSSION Besides conventional methods for hemos-/lymphostasis several adjunct measures like fibrin sealants, medication with corticoids and diurectics have been proposed for seroma prevention/therapy, unfortunately, with conflicting evidence. In an experimental study seroma prevention with a polysaccharide was demonstrated; however, clinical proof is missing. This case provides first clinical evidence that 4DryField® PH polysaccharide powder evenly distributed in the former seroma cavity can prevent its recurrence. CONCLUSION 4DryField® PH powder treatment of seroma is a promising new approach for prevention and treatment of chronic seroma.
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Affiliation(s)
- Andreas Kuthe
- Department of General Surgery and Traumatology, DRK-Krankenhaus, Clementinenhaus, Lützerodestr. 1, 30161 Hannover, Germany.
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Operative correction of abdominal rectus diastasis (ARD) reduces pain and improves abdominal wall muscle strength: A randomized, prospective trial comparing retromuscular mesh repair to double-row, self-retaining sutures. Surgery 2016; 160:1367-1375. [PMID: 27475817 DOI: 10.1016/j.surg.2016.05.035] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 05/13/2016] [Accepted: 05/30/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND The primary aim of this prospective, randomized, clinical, 2-armed trial was to evaluate the risk for recurrence using 2 different operative techniques for repair of abdominal rectus diastasis. Secondary aims were comparison of pain, abdominal muscle strength, and quality of life and to compare those outcomes to a control group receiving physical training only. METHODS Eighty-six patients were enrolled. Twenty-nine patients were allocated to retromuscular polypropylene mesh and 27 to double-row plication with Quill technology. Thirty-two patients participated in a 3-month training program. Diastasis was evaluated with computed tomography scan and clinically. Pain was assessed using the ventral hernia pain questionnaire, a quality-of-life survey, SF-36, and abdominal muscle strength using the Biodex System-4. RESULTS One early recurrence occurred in the Quill group, 2 encapsulated seromas in the mesh group, and 3 in the suture group. Significant improvements in perceived pain, the ventral hernia pain questionnaire, and quality of life appeared at the 1-year follow-up with no difference between the 2 operative groups. Significant muscular improvement was obtained in all groups (Biodex System-4). Patient perceived gain in muscle strength assessed with a visual analog scale improved similarly in both operative groups. This improvement was significantly greater than that seen in the training group. Patients in the training group still experienced bodily pain at follow-up. CONCLUSION There was no difference between the Quill technique and retromuscular mesh in the effect on abdominal wall stability, with a similar complication rate 1 year after operation. An operation improves functional ability and quality of life. Training strengthens the abdominal muscles, but patients still experience discomfort and pain.
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Sucupira E, Matta R, Zuker P, Matta J, Uebel CO. Inguinal Fold as a Closed-Suction Drain Exit Site in Abdominoplasty. Aesthetic Plast Surg 2015; 39:1022-4. [PMID: 26487656 DOI: 10.1007/s00266-015-0572-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 10/01/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Eduardo Sucupira
- General and Plastic Surgery Department, Santa Casa da Misericórdia Hospital of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Renato Matta
- Plastic Surgery Department, São Lucas Hospital of PUC-RS, Porto Alegre, Brazil.
| | - Patrícia Zuker
- General and Plastic Surgery Department, Santa Casa da Misericórdia Hospital of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jorge Matta
- Plastic Surgery Resident, Materno Infantil Perinatal Institute, Recife, Brazil
| | - Carlos O Uebel
- Plastic Surgery Department, São Lucas Hospital of PUC-RS, Porto Alegre, Brazil
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Abstract
BACKGROUND Abdominoplasty is one of the most performed aesthetic surgical procedures, and seroma is a common local complication. The aim of this study was to investigate the beginning of seroma formation after abdominoplasty and its progression. METHODS Twenty-one female patients underwent standard abdominoplasty. To investigate seroma formation, abdominal ultrasound was performed in five regions of the abdominal wall (i.e., epigastric, umbilical, hypogastric, right iliac fossa, and left iliac fossa regions) at five different time points: postoperative days 4, 11, 18, 25, and 32. RESULTS The incidence of seroma was 4.8 percent on postoperative day 4, 38.1 percent on postoperative day 11, 33.3 percent on postoperative day 18, 23.8 percent on postoperative day 25, and 19 percent on postoperative day 32. The left iliac fossa region had the highest relative volume of fluid collection on postoperative day 4, as did both the right iliac fossa and left iliac fossa regions on postoperative day 11. At other time points, the relative volume of fluid collection was significantly higher in the right iliac fossa region. CONCLUSION The highest incidence of seroma occurred on postoperative day 11, and the iliac fossae were the most common locations of seroma.
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Rangaswamy M. Minimising complications in abdominoplasty: An approach based on the root cause analysis and focused preventive steps. Indian J Plast Surg 2014; 46:365-76. [PMID: 24501473 PMCID: PMC3901918 DOI: 10.4103/0970-0358.118615] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Significant complications still occur after abdominoplasty, the rate varies widely in different series. This variation suggests that there is a lot of scope for improvement. This paper reviews the various complications and also the technical improvements reported in the last 20 years. The root cause of each complication is analysed and preventive steps are suggested based on the literature and the author's own personal series with very low complication rates. Proper case selection, risk stratified prophylaxis of thromboembolism, initial synchronous liposuction, flap elevation at the Scarpa fascia level, discontinuous incremental flap dissection, vascular preservation and obliteration of the sub-flap space by multiple sutures emerge as the strongest preventive factors. It is proposed that most of the complications of abdominoplasty are preventable and that it is possible to greatly enhance the aesthetic and safety profile of this surgery.
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Affiliation(s)
- Mohan Rangaswamy
- Plastic Surgery Department, American Academy of Cosmetic Surgery Hospital, Dubai Healthcare City, Dubai, U.A.E
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Seroma and Quilting Suture at the Donor Site of the TRAM Flap in Breast Reconstruction. Ann Plast Surg 2014; 72:391-7. [DOI: 10.1097/sap.0b013e3182610b11] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Stebbins WG, Hanke CW, Petersen J. Ultrasound-guided drainage of a seroma following tumescent liposuction. Dermatol Ther 2011; 24:121-4. [PMID: 21276164 DOI: 10.1111/j.1529-8019.2010.01384.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Of the complications that can occur following tumescent liposuction, seroma formation is unusual. It is a common practice for seromas to be aspirated blindly with a needle and syringe. We present a case of seroma formation following liposuction, with a subsequent step-by-step technical description of ultrasound-guided drainage of the seroma. Utilization of ultrasound provides a safe, effective method for aspirating seromas, allowing for accurate visualization and delineation of the seroma margins, proper needle placement, and monitoring of progress. It is a simple and useful tool in postprocedural management of patients undergoing liposuction.
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Affiliation(s)
- William G Stebbins
- The Laser and Skin Surgery Center of Indiana, Carmel, Indiana 46032, USA
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Seroma in lipoabdominoplasty and abdominoplasty: a comparative study using ultrasound. Plast Reconstr Surg 2010; 126:1742-1751. [PMID: 20639797 DOI: 10.1097/prs.0b013e3181efa6c5] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Abdominoplasty is one of the most frequently performed cosmetic procedures, and its combination with liposuction has become more common. Seroma is one of the most common complications in abdominoplasty. The aim of this study was to compare the rate of seroma formation in patients who underwent either abdominoplasty with or without the use of quilting sutures or lipoabdominoplasty. METHODS Fifty-eight female patients were divided into three groups and underwent one of the following procedures: group A (n=21), abdominoplasty without quilting sutures; group B (n=17), abdominoplasty with quilting sutures; and group C (n=20), lipoabdominoplasty. To investigate seroma formation, abdominal ultrasound was performed in five regions of the abdominal wall (epigastrium, umbilical, hypogastrium, right iliac fossa, and left iliac fossa) at two postoperative periods (P1, between postoperative days 11 and 14; and P2, between postoperative days 18 and 21). RESULTS The rate of seroma formation at both P1 and P2 was significantly higher in group A. It was observed that in group A at P1, the regions of right iliac fossa and left iliac fossa developed larger fluid collections. In group B, there were no significant differences with respect to fluid collections among the five study regions at both P1 and P2. In group C, there were significantly larger fluid collections in the hypogastrium region at P1 and in the umbilical and hypogastrium regions at P2. CONCLUSION Abdominoplasty with quilting sutures and lipoabdominoplasty are effective techniques for the prevention of seromas compared with abdominoplasty without quilting sutures.
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Shan CX, Zhang W, Jiang DZ, Zheng XM, Liu S, Qiu M. Prevalence, risk factors, and management of seroma formation after breast approach endoscopic thyroidectomy. World J Surg 2010; 34:1817-22. [PMID: 20414774 DOI: 10.1007/s00268-010-0597-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Breast approach endoscopic thyroidectomy (BAET) allows surgeons to remove a thyroid tumor from a remote site while providing a scarless cosmetic appearance in the neck. However, seroma formation after subcutaneous dissection could lead to flap detachment, incision dehiscence, and wound infection. Chronic formation of seromas could substantially compromise the esthetic outcome of BAET. We evaluated the prevalence, risk factors, and treatments of seroma after BAET. METHODS A total of 344 patients who underwent BAET between 2001 and 2008 at our institution were recruited; data were collected prospectively. The characteristics and outcomes of patients who developed seromas were compared with those of patients who did not. Regression analysis was used to identify the independent risk factors for seroma formation. The frequency and volume of aspirations were noted until the seroma went into remission. RESULTS The overall postoperative prevalence of seroma formation was 2.9%. There was a significant difference in seroma formation based on age, hypertension, body mass index (BMI), and area of subcutaneous dissection space (ASDS). Percutaneous aspiration alone or combined with external compression was extremely effective. The frequency and total volume of aspirations were 1-7 and 6-120 ml, respectively. As a result of prolonged seroma formation, one patient developed an expanding pseudo-bursa that created a tumor-like effect in the anterior chest wall. CONCLUSIONS Seroma formation was an uncommon minor complication after BAET. Four independent etiologic factors could predispose patients to postoperative seroma formation. Percutaneous aspiration appeared to be very effective. Prolonged seroma formation followed by development of a pseudo-bursa could be very problematic and could substantially impair the esthetic effect of BAET.
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Affiliation(s)
- Cheng-Xiang Shan
- Department of Minimally Invasive Surgery, Chang Zheng Hospital Affiliated to Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, China.
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Hatef DA, Trussler AP, Kenkel JM. Procedural Risk for Venous Thromboembolism in Abdominal Contouring Surgery: A Systematic Review of the Literature. Plast Reconstr Surg 2010; 125:352-362. [DOI: 10.1097/prs.0b013e3181c2a3b4] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Caulfield RH, Maleki-Tabrizi A, Khan F, Ramakrishnan V. A large encapsulated seroma presenting as a mass 5 years post paraumbilical hernia repair. J Plast Reconstr Aesthet Surg 2009; 62:105-7. [DOI: 10.1016/j.bjps.2007.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2007] [Revised: 02/11/2007] [Accepted: 08/21/2007] [Indexed: 11/28/2022]
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Dragu A, Bach AD, Polykandriotis E, Kneser U, Horch RE. Pseudotumors after Primary Abdominal Lipectomy as a New Sequela in Patients with Abdominal Apron. Obes Surg 2008; 19:1599-604. [DOI: 10.1007/s11695-008-9559-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2007] [Accepted: 11/08/2007] [Indexed: 11/30/2022]
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