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Casal D, Pais D, Iria I, Mota-Silva E, Almeida MA, Alves S, Pen C, Farinho A, Mascarenhas-Lemos L, Ferreira-Silva J, Ferraz-Oliveira M, Vassilenko V, Videira PA, Gory O'Neill J. A Model of Free Tissue Transfer: The Rat Epigastric Free Flap. J Vis Exp 2017. [PMID: 28117814 PMCID: PMC5352260 DOI: 10.3791/55281] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Free tissue transfer has been increasingly used in clinical practice since the 1970s, allowing reconstruction of complex and otherwise untreatable defects resulting from tumor extirpation, trauma, infections, malformations or burns. Free flaps are particularly useful for reconstructing highly complex anatomical regions, like those of the head and neck, the hand, the foot and the perineum. Moreover, basic and translational research in the area of free tissue transfer is of great clinical potential. Notwithstanding, surgical trainees and researchers are frequently deterred from using microsurgical models of tissue transfer, due to lack of information regarding the technical aspects involved in the operative procedures. The aim of this paper is to present the steps required to transfer a fasciocutaneous epigastric free flap to the neck in the rat. This flap is based on the superficial epigastric artery and vein, which originates from and drain into the femoral artery and vein, respectively. On average the caliber of the superficial epigastric vein is 0.6 to 0.8 mm, contrasting with the 0.3 to 0.5 mm of the superficial epigastric artery. Histologically, the flap is a composite block of tissues, containing skin (epidermis and dermis), a layer of fat tissue (panniculus adiposus), a layer of striated muscle (panniculus carnosus), and a layer of loose areolar tissue. Succinctly, the epigastric flap is raised on its pedicle vessels that are then anastomosed to the external jugular vein and to the carotid artery on the ventral surface of the rat's neck. According to our experience, this model guarantees the complete survival of approximately 70 to 80% of epigastric flaps transferred to the neck region. The flap can be evaluated whenever needed by visual inspection. Hence, the authors believe this is a good experimental model for microsurgical research and training.
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Affiliation(s)
- Diogo Casal
- Anatomy Department, NOVA Medical School, Universidade NOVA de Lisboa; CEDOC, NOVA Medical School, Universidade NOVA de Lisboa;
| | - Diogo Pais
- Anatomy Department, NOVA Medical School, Universidade NOVA de Lisboa
| | - Inês Iria
- UCIBIO, Life Sciences Department, Faculty of Sciences and Technology, Universidade NOVA de Lisboa; CEDOC, NOVA Medical School, Universidade NOVA de Lisboa
| | | | - Maria-Angélica Almeida
- Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central - Hospital de São José
| | - Sara Alves
- Pathology Department, Centro Hospitalar de Lisboa Central - Hospital de São José
| | - Cláudia Pen
- Pathology Department, Centro Hospitalar de Lisboa Central - Hospital de São José
| | - Ana Farinho
- CEDOC, NOVA Medical School, Universidade NOVA de Lisboa
| | - Luís Mascarenhas-Lemos
- Anatomy Department, NOVA Medical School, Universidade NOVA de Lisboa; Pathology Department, Centro Hospitalar de Lisboa Central - Hospital de São José
| | - José Ferreira-Silva
- Pathology Department, Centro Hospitalar de Lisboa Central - Hospital de São José
| | | | | | - Paula A Videira
- UCIBIO, Life Sciences Department, Faculty of Sciences and Technology, Universidade NOVA de Lisboa; CEDOC, NOVA Medical School, Universidade NOVA de Lisboa
| | - João Gory O'Neill
- Anatomy Department, NOVA Medical School, Universidade NOVA de Lisboa; Physics Department, Faculty of Sciences and Technology, LIBPhys
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Dunda SE, Krings LK, Ranker MF, Wruck C, van Neerven SG, Bozkurt A, Pallua N. Effect of Immunocompromising Therapy on In Vivo Cell Survival in Musculoskeletal Tissue Engineering. J Med Biol Eng 2015. [DOI: 10.1007/s40846-015-0017-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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3
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Combined Semimembranosus Muscle and Epigastric Skin Flap Model. Plast Reconstr Surg 2015. [DOI: 10.1007/978-1-4471-6335-0_29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Jankau J. Free TRAM Flap Model. Plast Reconstr Surg 2015. [DOI: 10.1007/978-1-4471-6335-0_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Edmunds MC, Wigmore S, Kluth D. In situ transverse rectus abdominis myocutaneous flap: a rat model of myocutaneous ischemia reperfusion injury. J Vis Exp 2013. [PMID: 23770929 DOI: 10.3791/50473] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Free tissue transfer is the gold standard of reconstructive surgery to repair complex defects not amenable to local options or those requiring composite tissue. Ischemia reperfusion injury (IRI) is a known cause of partial free flap failure and has no effective treatment. Establishing a laboratory model of this injury can prove costly both financially as larger mammals are conventionally used and in the expertise required by the technical difficulty of these procedures typically requires employing an experienced microsurgeon. This publication and video demonstrate the effective use of a model of IRI in rats which does not require microsurgical expertise. This procedure is an in situ model of a transverse abdominis myocutaneous (TRAM) flap where atraumatic clamps are utilized to reproduce the ischemia-reperfusion injury associated with this surgery. A laser Doppler Imaging (LDI) scanner is employed to assess flap perfusion and the image processing software, Image J to assess percentage area skin survival as a primary outcome measure of injury.
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Acar Y, Bozkurt M, Firat U, Selcuk CT, Kapi E, Isik FB, Kuvat SV, Celik F, Bozarslan BH. A comparison of the effects of epidural and spinal anesthesia with ischemia-reperfusion injury on the rat transverse rectus abdominis musculocutaneous flap. Ann Plast Surg 2012. [PMID: 23187711 DOI: 10.1097/sap.0b013e31824f220e] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The purpose of this study is to compare the effects of spinal and epidural anesthesia on a rat transverse rectus abdominus myocutaneous flap ischemia-reperfusion injury model.Forty Sprague-Dawley rats were divided into 4 experimental groups: group I (n = 10), sham group; group II (n = 10), control group; group III (n = 10), epidural group; and group IV (n = 10), spinal group. After the elevation of the transverse rectus abdominus myocutaneous flaps, all groups except for the sham group were subjected to normothermic no-flow ischemia for 4 hours, followed by a reperfusion period of 2 hours. At the end of the reperfusion period, biochemical and histopathological evaluations were performed on tissue samples.Although there was no significant difference concerning the malonyldialdehyde, nitric oxide, and paraoxonase levels in the spinal and epidural groups, the total antioxidant state levels were significantly increased, and the total oxidative stress levels were significantly decreased in the epidural group in comparison to the spinal group. The pathological evaluation showed that findings related to inflammation, nuclear change rates and hyalinization were significantly higher in the spinal group compared with the epidural group.Epidural anesthesia can be considered as a more suitable method that enables a decrease in ischemia-reperfusion injuries in the muscle flaps.
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Affiliation(s)
- Yusuf Acar
- From the *Department of Plastic, Reconstructive and Aesthetic Surgery and Burn Center; †Department of Pathology, Dicle University Medical Faculty, Diyarbakir, Turkey; ‡Department of Plastic, Reconstructive and Aesthetic Surgery, Sirnak State Hospital, Sirnak; §Department of Biochemistry, Dicle University Medical Faculty, Diyarbakir; ∥Department of Plastic, Reconstructive and Aesthetic Surgery, Istanbul University Istanbul Medical Faculty, Istanbul; ¶Department of Anaesthesia and Reanimation, Dicle University Medical Faculty, Diyarbakir; and #Department of Biochemistry, Cizre State Hospital, Sirnak, Turkey
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A new approach of in vivo musculoskeletal tissue engineering using the epigastric artery as central core vessel of a 3-dimensional construct. PLASTIC SURGERY INTERNATIONAL 2012; 2012:510852. [PMID: 22570779 PMCID: PMC3335622 DOI: 10.1155/2012/510852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2011] [Accepted: 12/05/2011] [Indexed: 11/17/2022]
Abstract
The creation of musculoskeletal tissue represents an alternative for the replacement of soft tissue in reconstructive surgery. However, most of the approaches of creating artificial tissue have their limitations in the size as the maximally obtainable dimension of bioartificial tissue (BAT) is limited due to the lack of supporting vessels within the 3-dimensional construct. The seeded myoblasts require high amounts of perfusion, oxygen, and nutrients to survive. To achieve this, we developed a 3-dimensional scaffold which features the epigastric artery as macroscopic core vessel inside the BAT in a rat model (perfused group, n = 4) and a control group (n = 3) without the epigastric vessels and, therefore, without perfusion. The in vivo monitoring of the transplanted myoblasts was assessed by bioluminescence imaging and showed both the viability of the epigastric artery within the 3-dimensional construct and again that cell survival in vivo is highly depending on the blood supply with the beginning of capillarization within the BAT seven days after transplantation in the perfused group. However, further studies focussing on the matrix improvement will be necessary to create a transplantable BAT with the epigastric artery as anastomosable vessel.
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Large Antigenic Skin Load in Total Abdominal Wall Transplants Permits Chimerism Induction. Ann Plast Surg 2008; 61:572-9. [DOI: 10.1097/sap.0b013e31816d8275] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tyner TR, Tong W, Donovan K, McDonald T, Sian K, Yamaguchi KT. Dichloroacetate Reduces Tissue Necrosis in a Rat Transverse Rectus Abdominis Musculocutaneous Flap Model. Ann Plast Surg 2006; 56:320-6. [PMID: 16508366 DOI: 10.1097/01.sap.0000194549.39544.cd] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Ischemia-related complications may occur during postmastectomy transverse rectus abdominis musculocutaneous (TRAM) flap reconstruction. The aim of our study was to investigate whether necrosis of susceptible flap regions could be reduced by dichloroacetate (DCA)-induced stimulation of oxidative metabolism in hypoxic tissue. METHODS The study was a randomized control trial using male Sprague-Dawley rats. A pedicled TRAM flap based upon the right inferior epigastric artery was elevated and reapproximated. Animals were randomly assigned to 1 of 5 treatment groups (n = 6). Group I received no DCA; groups II through V were administered 75 mg/kg DCA orally 24 hours preoperative; in addition, groups II through IV received 75 mg/kg/d DCA orally postoperative for 4 days; group III also received 75 mg/kg DCA (IP) intraoperatively; groups IV and V were given 15 mg/kg/d DCA orally for 6 days before the 24-hour preoperative treatment. Four days postsurgery, skin paddles were photographed and assessed for viability. Underlying TRAM muscle was biopsied for histologic analysis. Blood lactate levels were measured at pre- and postoperative time points. The mean percentages of viable skin paddle were as follows: 32.0%+/- 4.0% (group I), 68.1% +/- 6.2% (group II), 84.3% +/- 5.9% (group III), 92.8% +/- 2.0% (group IV), 82.6% +/- 5.8% (group V). RESULTS Statistically significant differences were found in all experimental (DCA) groups relative to the controls (P < 0.01). Group IV (6-day DCA preconditioning, plus 24-hour preoperative and 4-day postoperative treatment) displayed the greatest improvement in flap viability, significantly better than other DCA groups (P < 0.01). Group IV also had significantly lower serum lactate levels than controls (P < 0.05). Histologic examination of muscle biopsies revealed reductions in inflammation and necrosis correlating with DCA treatment and skin paddle survival. CONCLUSIONS This study indicates that DCA may provide a useful pharmacologic tool for reducing ischemia-related necrosis in TRAM flaps.
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Affiliation(s)
- Tim R Tyner
- Department of Surgery, University Medical Center, Veterans Administration Medical Center, University of California San Francisco-Fresno Medical Education Program, CA 93702, USA
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Ozkan O, Coskunfirat OK, Ozgentas HE, Yildirim I, Dikici MB. Is it Possible to Increase the Survival of the Transverse Rectus Abdominis Musculocutaneous Flap following previous Abdominoplasty Using a Delay Procedure? An Experimental Study in the Rat. Plast Reconstr Surg 2005; 116:1945-52. [PMID: 16327608 DOI: 10.1097/01.prs.0000189200.26927.ce] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although, because of the disruption of perforators, abdominoplasty has been suggested as a major contraindication for patients undergoing autologous breast reconstruction with the transverse rectus abdominis musculocutaneous (TRAM) flap, many researchers encourage the search for a means of improving the survival of the skin paddle of the flap in patients who have undergone previous abdominoplasty. In this study, the effect of the surgical delay phenomenon on the survival of the TRAM flap following abdominoplasty was investigated. METHODS Thirty adult Wistar rats were used: the control group (n = 6), the short-term group (n = 12), and the long-term group (n = 12). In the control group, a standard superior pedicled TRAM flap was harvested with no abdominoplasty procedure, and the flap was replaced in situ. In all other animals, an abdominoplasty procedure was performed initially. The short-term and long-term groups were divided into two subgroups: the abdominoplasty plus TRAM-only subgroup (n = 6), and the abdominoplasty plus delay plus TRAM subgroup (n = 6). In the short-term group, the experiment was performed 1 month after abdominoplasty, whereas the same surgical procedures were applied 6 months after abdominoplasty in the long-term group. RESULTS The short-term abdominoplasty plus TRAM subgroup, the long-term abdominoplasty plus TRAM subgroup, the short-term abdominoplasty plus delay plus TRAM subgroup, the long-term abdominoplasty plus delay plus TRAM subgroup, and the conventional superior pedicled TRAM flap group showed 2.33 +/- 3.01 percent, 13.33 +/- 8.76 percent, 24.17 +/- 13.57 percent, 60 +/- 8.94 percent, and 70.83 +/- 9.70 percent survival rates for the skin paddle, respectively. CONCLUSION The data demonstrate that surgical delay after long-term abdominoplasty can enhance the survival rate of the skin paddle of the TRAM flap.
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Affiliation(s)
- Omer Ozkan
- Department of Plastic and Reconstructive Surgery, Akdeniz University School of Medicine, Antalya, Turkey.
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Abstract
We present a new model of combined semimembranosus muscle and epigastric skin free flap based on a single pedicle consisting of the muscular branch of semimembranosus muscle and superficial epigastric vessels in continuity with femoral vessels. In 10 rats, the anatomy of the semimembranosus muscle was studied in detail. The mean length of the muscle was 38 mm and width was 11 mm. The mean weight of the muscle was 1.03 g. The mean external diameter of the femoral artery was 1 mm and vein was 1.2 mm. Eight combined semimembranosus/epigastric skin flaps were dissected and transferred into the neck and contralateral groin regions with 100% success rate. This model of combined muscle and skin flap has several advantages. It is reliable, versatile, easy to dissect with long vascular pedicle and adequate vessel diameter for the anastomoses. It can be used for different applicability, including microcirculatory, pharmacologic, physiological, biochemical, and immunologic studies.
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Affiliation(s)
- Galip Agaoglu
- Department of Plastic Surgery, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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Losken A, Swartz MA, Van Den Abbeele AD, Jain RK, Slavin SA. A potential murine model for flap-related investigations. Plast Reconstr Surg 2001; 107:1504-8. [PMID: 11335827 DOI: 10.1097/00006534-200105000-00032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- A Losken
- Division of Plastic Surgery, Emory University; the Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
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Zhang F, Fischer K, Komorowska-Timek E, Guo M, Cui D, Dorsett-Martin W, Buncke HJ, Lineaweaver WC. Improvement of skin paddle survival by application of vascular endothelial growth factor in a rat TRAM flap model. Ann Plast Surg 2001; 46:314-9. [PMID: 11293526 DOI: 10.1097/00000637-200103000-00019] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The effect of vascular endothelial growth factor (VEGF) on skin flap survival and its ability to induce a pharmacological delay by promoting angiogenesis in a flap was studied in a rat transverse rectus abdominis musculocutaneous flap, using a 3 x 8-cm skin paddle with the inferior epigastric vessels as its main vascular supply. Forty-three Sprague-Dawley rats were divided into four groups. In group 1, VEGF was injected into the femoral vein after the flap was elevated. In group 2, VEGF was injected intra-arterially into the flap through the superior epigastric artery after the flap was elevated. In group 3, VEGF was injected into the subcutaneous fascial layer in the area where the flap would be dissected, and the flap was then raised 7 days after injection. In group 4, the flap was dissected and replaced, using saline injection as the control. On postoperative day 5, the survival area of each skin paddle was measured and the flap was harvested for histological analysis. The results showed that the mean survival area +/- standard deviation for the skin paddle was 6.82 +/- 4.89 cm2 (28.4 +/- 20.4% of the whole skin paddle) in the control group, and 4.2 +/- 3.0 cm2 (17.5 +/- 12.5%) and 6.02 +/- 5.97 cm2 (25.1 +/- 24.9%) in the groups with VEGF systemic and intra-arterial administration respectively. The skin survival area in the group with preoperative subcutaneous administration of VEGF was 17.85 +/- 2.88 cm2 (74.4 +/- 12%), which was significantly higher than the other three groups (p < 0.01). Histological semiquantitative analysis showed increased neovascularization in the flap treated with VEGF preoperatively. The data demonstrate that preoperative treatment with VEGF can induce angiogenesis and enhance skin paddle survival in a musculocutaneous flap.
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Affiliation(s)
- F Zhang
- Division of Plastic Surgery, University of Mississippi Medical Center, Jackson 39216, USA
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Blanchard J, Massad M, Sekosan M, Dunn T, Raofi V, Holman D, Ramasastry S, Lutrin F, Benedetti E. A new rat model to study the correlation of cardiac and skeletal muscle allograft rejection. Microsurgery 2000; 18:406-9. [PMID: 9880155 DOI: 10.1002/(sici)1098-2752(1998)18:7<406::aid-micr3>3.0.co;2-2] [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: 11/06/2022]
Abstract
As a first step to study the correlation of cardiac and skeletal muscle allograft rejection, we describe a new experimental rat model of simultaneous heterotopic heart and cutaneous maximus muscle flap allotransplant. Brown Norway rats were used as donors and Lewis rats as recipients. No immunosuppression was given. The grafts were revascularized with sequential end-to-side anastomosis of each vascular pedicle to the infrarenal aorta and vena cava. Syngeneic heart and cutaneous maximus muscle grafts remained functional and showed no sign of rejection at 7 days after the transplant. In contrast, both allografts developed severe rejection and functional compromise at 7 days after the transplant. Our experimental model is technically feasible and reproducible and may provide important information about the pattern of rejection of cardiac and skeletal muscle allografts.
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Affiliation(s)
- J Blanchard
- Department of Surgery, University of Illinois at Chicago, USA
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Abstract
The rat pectoralis muscle can serve as a vascularized, innervated muscle flap model. The muscle, consisting of superficialis and profundus portions, is supplied by separate neurovascular systems. The vessels to pectoralis profundus (averaging 0.3 mm in diameter) can be taken in continuity with the axillary vessels (averaging 11 mm in diameter), which are used for transplantation. The profundus portion of muscle weighed an average of 1.8 g, and the average pedicle length was 0.9 cm. Nine of 11 transplanted muscles were viable, with intact circulation at 72 hours. An example of muscle transplantation for tissue defect coverage was attempted. The pectoralis profundus transplant was technically reliable, and the muscle bulk and contour could allow biochemical and functional studies.
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Affiliation(s)
- F Zhang
- Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, CA 94305, USA
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