1
|
Xu J, Zhao Y. Effect of high-density fat combined with adipose stem cell glue on the success rate of facial filling and its clinical value. J Plast Surg Hand Surg 2024; 59:32-39. [PMID: 38481120 DOI: 10.2340/jphs.v59.18683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/08/2024] [Indexed: 03/26/2024]
Abstract
Facial fat grafting is a popular cosmetic procedure, and experts are increasingly endorsing the use of high-density fat with adipose stem cell glue for better results. This study aims to explore the effect of high-density fat combined with adipose stem cell glue on the success rate of facial filling and its clinical value. We conducted a randomized trial with 100 patients who underwent facial fat transplantation between August 2020 and August 2022. They were divided into two groups: a control group receiving traditional Coleman fat transplantation and an observation group receiving high-density fat with adipose stem cells. In the observation and control groups, the excellent and good rate was 98.00 and 80.00%. After 3 months of treatment, the thickness of frontal subcutaneous fat and temporal subcutaneous fat in the observation group was higher (P < 0.05). Observation group retention of fat transplantation was noticeably higher 3 months after treatment (P < 0.05). Three months after treatment, the VISIA (facial imaging system) scores of facial color spots, facial pores and facial wrinkles in the observation group were lower (P < 0.05). After treatment, both groups indicated noticeable improvements in physiological functions, health status, social function, mental health, and somatic diseases compared to before treatment. Notably, the observation group had higher scores (P < 0.05). The observation group had a lower complication rate (4.00% vs. 22.00%) and higher satisfaction rate (98.00% vs. 86.00%) than the control group. Using high-density fat combined with adipose stem cell glue for facial fat grafting yields superior results, reduces complications, and boosts patient satisfaction compared to traditional methods. We have complied with all relevant ethical regulations with regard to the use of stem cells.
Collapse
Affiliation(s)
- Junsheng Xu
- Hefei BOE Hospital, Hefei City, Anhui Province, China
| | - Yu Zhao
- The First Affiliated Hospital of Anhui Medical University, Hefei City, Anhui Province, China.
| |
Collapse
|
2
|
Yuan Y, Chai H, Wang L, Yuan L, Li F, Zhou Y, Cao Y, Liu M, Li Q, Li S. The Buried Guide Suture Method: A Novel Technique to Correct Traumatic Facial Dimples. Plast Reconstr Surg 2024; 153:692-695. [PMID: 37053457 DOI: 10.1097/prs.0000000000010549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
SUMMARY Facial dimpling, frequently occurring after blunt trauma, presents as soft-tissue depression, which is particularly apparent during facial expression. The displacement of subcutaneous tissue can be detected and measured by high-frequency ultrasound. Limited surgical methods have been applied in these closed-injury cases. Repositioning the subcutaneous tissue without incisions on unscarred skin is challenging. The authors propose a novel three-dimensional technique to suture and fix the subcutaneous tissue at a distance through a concealed incision. The buried guide suture method was used in the treatment of 22 patients with traumatic facial dimples on the cheek. All patients showed great improvement in their depressed deformity with minor complications. This technique provides an option to correct soft-tissue depression without leaving a visible scar, especially for mimetic rupture caused by blunt trauma.
Collapse
Affiliation(s)
| | | | - Lianzhao Wang
- Comprehensive Treatment Center of Scar, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College
| | - Li Yuan
- Ultrasonic Diagnosis Department
| | | | | | | | | | | | | |
Collapse
|
3
|
Boschetti CE, Vitagliano R, Cornacchini N, Santagata M, Caliendo V, Belfiore MP, Colella G, Tartaro G, Cappabianca S. Safety and Aesthetics of Autologous Dermis-Fat Graft after Parotidectomy: A Multidisciplinary Retrospective Study. J Pers Med 2023; 13:1200. [PMID: 37623451 PMCID: PMC10456015 DOI: 10.3390/jpm13081200] [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: 07/11/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/26/2023] Open
Abstract
(1) Background: In surgical procedures for maxillofacial tumours, it is challenging to preserve functional and cosmetic properties in the affected patients. The use of fat grafting is considered as a valuable alternative to overcome postoperative aesthetic asymmetry problems. (2) Methods: In this study, we enrolled thirty patients with parotid gland tumours in which a partial or complete parotidectomy was performed with positioning in the parotid bed of autologous dermis-fat grafts. We evaluated the satisfaction rate of the patients and the objective efficacy in solving the deformity by comparing MRI data before and after surgery. (3) Results: Twenty-six patients showed a satisfying cosmetic result with proper facial symmetry between the affected side and the healthy one. Two patients presented mild postsurgical complications such as haematomas, and two patients reported temporary weakness of the facial nerve related to the parotidectomy. (4) Conclusions: Based on the imaging data obtained via MRI before and after surgery, we can assess that the employment of fat grafts in parotidectomy surgical procedures gives good cosmetic results and does not affect the post operative management and follow up of oncologic patients.
Collapse
Affiliation(s)
- Ciro Emiliano Boschetti
- Oral and Maxillofacial Surgery Unit, Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (C.E.B.); (N.C.); (M.S.); (G.C.); (G.T.)
| | - Rita Vitagliano
- Oral and Maxillofacial Surgery Unit, Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (C.E.B.); (N.C.); (M.S.); (G.C.); (G.T.)
| | - Nicola Cornacchini
- Oral and Maxillofacial Surgery Unit, Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (C.E.B.); (N.C.); (M.S.); (G.C.); (G.T.)
| | - Mario Santagata
- Oral and Maxillofacial Surgery Unit, Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (C.E.B.); (N.C.); (M.S.); (G.C.); (G.T.)
| | - Valentina Caliendo
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia, 80138 Naples, Italy; (V.C.); (M.P.B.); (S.C.)
| | - Maria Paola Belfiore
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia, 80138 Naples, Italy; (V.C.); (M.P.B.); (S.C.)
| | - Giuseppe Colella
- Oral and Maxillofacial Surgery Unit, Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (C.E.B.); (N.C.); (M.S.); (G.C.); (G.T.)
| | - Gianpaolo Tartaro
- Oral and Maxillofacial Surgery Unit, Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (C.E.B.); (N.C.); (M.S.); (G.C.); (G.T.)
| | - Salvatore Cappabianca
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia, 80138 Naples, Italy; (V.C.); (M.P.B.); (S.C.)
| |
Collapse
|
4
|
Atiyeh B, Emsieh S. Comment on: Ultrasound-Assisted Liposuction (UAL) Arm Contouring in Non-post-bariatric Patients-No Rush for Brachioplasty. Aesthetic Plast Surg 2023; 47:159-161. [PMID: 36171404 DOI: 10.1007/s00266-022-03122-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/08/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Bishara Atiyeh
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Saif Emsieh
- American University of Beirut Medical Center, Beirut, Lebanon.
| |
Collapse
|
5
|
Saadoun R, Solari MG, Rubin JP. The Role of Autologous Fat Grafting in Rhinoplasty. Facial Plast Surg 2023; 39:185-189. [PMID: 36100254 DOI: 10.1055/a-1942-2225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Rhinoplasty is one of the most popular aesthetic surgeries worldwide and often includes grafting techniques to achieve optimal results. One of these grafting techniques is autologous fat transfer, which has been used to increase volume, camouflage irregularities, and/or improve the quality of the nasal skin-soft tissue envelope. Moreover, minimally invasive approaches for altering the nasal appearance have recently increased and become known as "liquid" or "nonsurgical rhinoplasty." These nonsurgical approaches include altering the nasal appearance with filler injection to induce volumetric changes in lieu of extensive surgery. The use of fat grafting as a filler is favorable to achieve well-balanced aesthetic results without compromising the nasal skin-soft tissue envelope. This capability is partly because of the regenerative potential of fat grafts, serving to improve the quality of surrounding soft tissues. In contrast, commercial injectable fillers are inert. This article highlights the role of fat grafting in surgical and nonsurgical rhinoplasty to provide surgeons with an overview of the potential of these vastly abundant, biocompatible, and cost-effective grafts.
Collapse
Affiliation(s)
- Rakan Saadoun
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
- Medical Faculty Mannheim, Ruprecht Karl University of Heidelberg, Mannheim, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Centre Mannheim, Mannheim, Germany
| | - Mario G Solari
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - J Peter Rubin
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| |
Collapse
|
6
|
Atiyeh B, Ghieh F, Oneisi A. Nanofat Cell-Mediated Anti-Aging Therapy: Evidence-Based Analysis of Efficacy and an Update of Stem Cell Facelift. Aesthetic Plast Surg 2021; 45:2939-2947. [PMID: 34085105 DOI: 10.1007/s00266-021-02353-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 05/09/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Fat grafting has been extensively applied as natural filler and has been very promising in restoring volume loss. Lipografting has also been credited to reduce age-related skin changes due to the regenerative potential of adipose derived stem cells. Cell-mediated therapies in plastic surgery are rapidly evolving with growing applications. Nanofat, a bio-regenerative liquid suspension rich in stromal vascular fraction cells without viable adipocytes, has been described as an efficient cutaneous anti-aging therapy. We have published in 2013 a review entitled "stem cell facelift: between reality and fiction." Available clinical evidence at that time did not substantiate marketing and promotional claims of "stem cell facelift". The same year, the report about nanofat was published demonstrating striking clinical outcome. The current literature search is aimed at reviewing any evidence that has emerged since then regarding clinical efficacy of this modality. METHODS A thorough PICO tool-based comprehensive literature search of PubMed database for "the efficacy of nanofat cell-mediated anti-aging therapy" was conducted with a time frame from 2013 till present. RESULTS Despite apparent increasing popularity of stem cell rejuvenation, well-controlled clinical studies about this modality are surprisingly very scarce. Only seven papers published after 2013 were identified and were included in this review CONCLUSION: Though considered to be a safe procedure, and despite documented histologic improvement and striking clinical outcome in some reports, available evidence can hardly support clinical improvement of skin quality. Before cell-mediated aesthetic rejuvenation applications can be routinely undertaken, more robust evidence with well-defined primary outcome end points and objective outcome measures is required. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Bishara Atiyeh
- Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fadi Ghieh
- Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ahmad Oneisi
- Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
| |
Collapse
|
7
|
Zhao H, Hao L, Chen X, Bai R, Luo S. An Efficacy Study of a New Radical Treatment for Acne Vulgaris Using Fat Injection. Aesthet Surg J 2021; 41:NP1061-NP1072. [PMID: 33821960 DOI: 10.1093/asj/sjab162] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Fat grafting is a popular operative approach for rejuvenation. Some patients requiring facial fat grafting also have acne. Fat grafting may improve acne in some patients. OBJECTIVES The aim of this study was to assess whether fat grafting can improve acne and to analyze the mechanism of action by which such improvement occurs. METHODS Preoperative and postoperative digital photographs were examined retrospectively in 229 patients who underwent fat grafting to compare the numbers of inflammatory acne lesions. In addition, 18 patients with acne who were treated by injection of subdermal stromal vascular fraction gel (SVF-gel) were examined prospectively. The numbers of inflammatory acne lesions before and after treatment were measured, and changes in the levels of CD4+ T-cell infiltration were determined from immunohistochemical staining. RESULTS Of the 229 retrospectively evaluated patients who underwent fat grafting, 22 had acne and had complete follow-up data; in these patients, the numbers of acne lesions were significantly lower after than before treatment. The 18 patients who received subdermal SVF-gel injection showed evident improvements in inflammatory lesions after more than 1 year of follow-up. CD4+ T-cell infiltration was significantly decreased at week 4. CONCLUSIONS Facial fat grafting can improve inflammatory acne lesions, perhaps because adipose-derived stem cells, which are plentiful in SVF-gel, reduce CD4+ T-cell-mediated inflammation responses. LEVEL OF EVIDENCE: 4
Collapse
Affiliation(s)
- Hongli Zhao
- Center of Plastic and Aesthetic Surgery, The First Affiliated Hospital of Harbin Medical University, Nangang, Harbin, People’s Republic of China
| | - Lijun Hao
- Center of Plastic and Aesthetic Surgery, The First Affiliated Hospital of Harbin Medical University, Nangang, Harbin, People’s Republic of China
| | - Xinyao Chen
- Center of Plastic and Aesthetic Surgery, The First Affiliated Hospital of Harbin Medical University, Nangang, Harbin, People’s Republic of China
| | - Ruoxue Bai
- Center of Plastic and Aesthetic Surgery, The First Affiliated Hospital of Harbin Medical University, Nangang, Harbin, People’s Republic of China
| | - Sai Luo
- Center of Plastic and Aesthetic Surgery, The First Affiliated Hospital of Harbin Medical University, Nangang, Harbin, People’s Republic of China
| |
Collapse
|
8
|
James IB, Gusenoff BR, Wang S, DiBernardo G, Minteer D, Gusenoff JA. A Step in the Right Direction: A Prospective Randomized, Controlled Crossover Trial of Autologous Fat Grafting for Rejuvenation of the Heel. Aesthet Surg J 2021; 41:NP959-NP972. [PMID: 33615336 DOI: 10.1093/asj/sjab095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The shock-absorbing soft tissues of the heel are composed of dermis and specialized fat pads. Heel fat pad atrophy is common and can be painful and debilitating. In our previous work, autologous fat grafting was effective for treating pain from forefoot fat pad atrophy. OBJECTIVES The authors hypothesized that autologous fat grafting to the heel would relieve pain and improve function in patients with heel fat pad atrophy. METHODS Patients with heel fat pad atrophy and associated pain were recruited and randomized into 2 groups. Group 1 received autologous fat grafting on enrollment and was followed for 2 years. Group 2 received offloading and activity modification for 1 year, then crossed over, underwent autologous fat grafting, and was followed for 1 year afterward. Outcome measures included ultrasound-measured fat pad and dermal thickness; pedobarograph-measured foot pressures and forces; and patient-reported outcomes as measured by the Manchester Foot Pain and Disability Index. RESULTS Thirteen patients met the inclusion criteria and completed the study. Seven (12 affected feet) were randomized into Group 1; and 6 (9 affected feet) were randomized into Group 2. The average age was 55 years and BMI was 30.5 kg/m2. Demographics did not significantly differ between groups. Heel fat pad thickness increased after autologous fat grafting but returned to baseline at 6 months. However, autologous fat grafting increased dermal thickness significantly and also increased fat pad thickness under a compressive load compared with controls at 6 and 12 months. Foot pain, function, and appearance were also significantly improved compared with controls at 6 and 12 months. CONCLUSIONS Autologous fat grafting improved patient-reported foot pain, function, and appearance and may rejuvenate local soft tissues in patients with heel fat pad atrophy. LEVEL OF EVIDENCE: 3
Collapse
Affiliation(s)
- Isaac B James
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Beth R Gusenoff
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Sheri Wang
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Gabriella DiBernardo
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Danielle Minteer
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | |
Collapse
|
9
|
Tunca M, Süslü NS, Karaosmanoğlu AA. Fat transfer after parotidectomy: fat resorption rates, aesthetic and functional outcomes of en-bloc fat graft versus lipofilling technique. Eur Arch Otorhinolaryngol 2021; 278:3933-3940. [PMID: 33471168 DOI: 10.1007/s00405-020-06570-y] [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: 11/09/2020] [Accepted: 12/11/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Reconstruction of parotidectomy involves the correction of facial contour abnormalities and prevention from Frey Syndrome. Reconstruction of parotidectomy field with autologous fat has not been popular among head and neck surgeons due to unclear predictability of fat resorption rates. The aim of this paper is to compare the fat resorption rates between different fat transfer techniques using radiologic measurements and reviewing the aesthetic and functional outcomes. METHODS We retrospectively reviewed medical records of patients, who underwent parotidectomy in Hacettepe University Hospital between 2015 and 2018. The aesthetic and functional outcomes of en-bloc fat graft and lipofilling techniques were compared among themselves, as well as with patients who had no reconstruction, using objective parameters. Fat resorption rates were compared using calculation of fat volumes obtained by MRI scans, 1 year after surgery. RESULTS Among 77 patients, 26 underwent reconstruction with en-bloc fat graft (P-EBFG); 21 patients reconstruction with lipofilling technique (P-LFT), whereas 30 patients had no reconstruction of parotidectomy field (P-NR). In three groups, there was no statistically significant difference in mean resected parotid tissue volumes (mean 18 ± 10.8 cm3, p = 0.754). We found a significant difference in decreased presence of Frey Syndrome and increased satisfation rates of cosmetic appearance in P-EBFG and P-LFT, in comparison to P-NR (p < 0.001). There was no significant difference in fat resorption rates between P-EBFG (50.75 + 21.20%) and P-LFT (48.59 + 17.93%) (p = 0.771). CONCLUSION Both en-bloc fat graft and lipofilling techniques have been found to be safe and to have similar fat resorption rates for reconstruction after parotidectomy.
Collapse
Affiliation(s)
- Merve Tunca
- Department of Otorhinolaryngology-Head and Neck Surgery, Hacettepe University Faculty of Medicine, Sıhhiye, 06100, Ankara, Turkey
| | - Nilda Sütay Süslü
- Department of Otorhinolaryngology-Head and Neck Surgery, Hacettepe University Faculty of Medicine, Sıhhiye, 06100, Ankara, Turkey.
| | - Ayça A Karaosmanoğlu
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| |
Collapse
|
10
|
Gold MH, Kinney BM, Kaminer MS, Rohrich RJ, D'Amico RA. A multi-center, open-label, pilot study of allograft adipose matrix for the correction of atrophic temples. J Cosmet Dermatol 2020; 19:1044-1056. [PMID: 32176417 DOI: 10.1111/jocd.13363] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 02/22/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Autologous fat grafting (AFG) and synthetic fillers are currently used in esthetic and reconstructive surgery. Challenges in AFG include inconsistent graft retention, donor site morbidities, insufficient harvest, and excessive harvesting times. An allograft adipose matrix (AAM) has been developed as an off-the-shelf alternative to AFG and synthetic fillers. AIMS To evaluate the clinical safety and retention of an AAM over 24 weeks after treatment of bilateral atrophic temples. PATIENTS/METHODS Ten subjects (nine females, one male, aged 47-69 years) with temple atrophy were enrolled in the IRB-approved study. AAM (Renuva® , MTF Biologics, Edison, NJ) was injected (<3 mL) bilaterally into the atrophic temples of each subject. Volume retention, global improvement, and safety were evaluated at 1, 4, 8, 12, 16, 20, and 24 weeks. Biopsy specimens were obtained for adipogenic and angiogenic histological evaluation. RESULTS The mean temple volume improved over the baseline and was retained throughout the study period. Fullness (measure of volume) increased immediately from 0 pretreatment to 2.8 post-treatment (scale 0-4 = none-maximum). Fullness varied from 0.8 to 2.2 from weeks 1 through 12 and was 2.7-3.0 from weeks 16-24, around 75% increase from baseline. Furthermore, skin tone, smoothness, texture, and overall appearance also improved with 71% of subjects being satisfied to very satisfied with the results. Adverse events were minimal and histology revealed native tissue incorporation and remodeling. CONCLUSION AAM is safe and well tolerated, provides at least 6-month volume retention, improves skin quality, and supports adipose tissue remodeling after treatment into temples.
Collapse
Affiliation(s)
- Michael H Gold
- Tennessee Clinical Research Center, Nashville, Tennessee
| | - Brian M Kinney
- Keck School of Medicine, University of Southern California, Beverly Hills, California
| | - Michael S Kaminer
- Yale School of Medicine, Skin Care Physicians, Inc, Chestnut Hill, Massachusetts
| | | | | |
Collapse
|
11
|
|