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Vascular Surgery333 papers

Multiple open mouth wounds

Last edited: 4/13/2026

Overview

Multiple open mouth wounds refer to complex, non-healing wounds that often defy standard healing processes, frequently seen in geriatric patients due to physiological changes and comorbidities 1310. These wounds pose significant challenges in terms of healing and management.

Diagnosis

  • Clinical Presentation: Presence of persistent open wounds that do not progress through normal healing phases 12.
  • Assessment Tools: Utilize wound assessment scales (e.g., Wagner scale for diabetic foot ulcers) to grade severity 113.
  • Laboratory Tests: Consider blood tests for nutritional status (e.g., vitamin D levels), infection markers, and underlying comorbidities 1124.
  • Imaging: Not typically required unless assessing vascular status (e.g., Doppler ultrasound for arterial insufficiency) 17.

    • Management

  • First-Line Treatments:
    • - Wound Debridement: Mechanical, enzymatic, or autolytic methods to remove necrotic tissue 113. - Moist Wound Healing Environment: Use appropriate dressings to maintain optimal moisture levels 219.
  • Adjunctive Treatments:
    • - Nutritional Support: Oral nutritional supplements to address deficiencies impacting healing 624. - Advanced Therapies: Low-frequency ultrasound, platelet-rich plasma (PRP), and hyperbaric oxygen therapy (HBOT) for selected cases 93031. - Bioengineered Skin Substitutes: Consider dehydrated human amnion chorion membrane (dHACM) allografts for dermal replacement 8. - Antimicrobial Dressings: Use MMP-inhibiting dressings to manage biofilm and promote healing 15.

    Special Populations

  • Elderly: Increased prevalence and complexity due to comorbidities like diabetes and malnutrition 11030.
  • Comorbidities: Management must address underlying conditions such as diabetes, vascular disease, and depression 11127.

    • Key Recommendations

  • Comprehensive Assessment: Include nutritional status, infection, and vascular health assessments in wound evaluation 124(Evidence: Strong).
  • Tailored Wound Care: Implement stage-appropriate debridement and moist wound healing strategies 113(Evidence: Strong).
  • Nutritional Optimization: Provide nutritional support to address deficiencies impacting wound healing 624(Evidence: Moderate).
  • Consider Advanced Therapies: Evaluate the use of PRP, HBOT, and bioengineered skin substitutes for refractory cases 93031(Evidence: Moderate).
  • Symptom Management: Focus on pain control and other wound-related symptoms, especially in palliative care settings 41(Evidence: Moderate).

    • References

    1 Dowling C, Chu L, Etkin Y, Oropallo A. Assessment and management of chronic venous, arterial, and diabetic wounds in older adults. Seminars in vascular surgery 2025. link 2 Sengul T, Kirkland-Kyhn H, Karadag A. Chronic Wounds and Dressings: An Overview of Management and Effectiveness. The Nursing clinics of North America 2025. link 3 Carpenter S, Lantis J, Ferguson A. The overlooked epidemic: the importance of treating 'other' open wounds in wound medicine. Journal of wound care 2025. link 4 Chomentowska E, Polak A, Grzybowski A. Holy Medicine: Patron Saints of Wounds Due to Animal Bites. Skinmed 2024. link 5 Wei M, Zheng H, Xu X, Ji Y, Yu X, Lu L et al.. Assessment of Wound-Related Pain Experiences of Patients With Chronic Wounds: A Multicenter Cross-Sectional Study in Eastern China. Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society 2024. link 6 Santo ACSDE, Sugizaki CSA, de Morais Junior AC, Costa NA, Bachion MM, Mota JF. Impact of oral nutritional supplement composition on healing of different chronic wounds: A systematic review. Nutrition (Burbank, Los Angeles County, Calif.) 2024. link 7 Dymarek R, Kuberka I, Walewicz K, Taradaj J, Rosińczuk J, Sopel M. Is Shock Wave Application Effective on Various Chronic Wounds in the Geriatric Population? Preliminary Clinical Study. Clinical interventions in aging 2024. link 8 Garcia N, Jiminez V, Graham L, Huang C. Unique Usages of Dehydrated Human Amnion Chorion Membrane Allografts in Dermatology. Journal of drugs in dermatology : JDD 2023. link 9 Chen H, Yu Z, Liu N, Huang J, Liang X, Liang X et al.. The efficacy of low-frequency ultrasound as an added treatment for chronic wounds: A meta-analysis. International wound journal 2023. link 10 Carter MJ, DaVanzo J, Haught R, Nusgart M, Cartwright D, Fife CE. Chronic wound prevalence and the associated cost of treatment in Medicare beneficiaries: changes between 2014 and 2019. Journal of medical economics 2023. link 11 Smith K, Hewlings S. Correlation between vitamin D levels and hard-to-heal wounds: a systematic review. Journal of wound care 2021. link 12 Chang AY, Mungai M, Coates SJ, Chao T, Odhiambo HP, Were PM et al.. Implementing a Locally Made Low-Cost Intervention for Wound and Lymphedema Care in Western Kenya. Dermatologic clinics 2021. link 13 Hoversten KP, Kiemele LJ, Stolp AM, Takahashi PY, Verdoorn BP. Prevention, Diagnosis, and Management of Chronic Wounds in Older Adults. Mayo Clinic proceedings 2020. link 14 Bowers S, Franco E. Chronic Wounds: Evaluation and Management. American family physician 2020. link 15 Dissemond J, Augustin M, Dietlein M, Faust U, Keuthage W, Lobmann R et al.. Efficacy of MMP-inhibiting wound dressings in the treatment of chronic wounds: a systematic review. Journal of wound care 2020. link 16 Kamath P, Agarwal N, Salgado CJ, Kirsner R. Wound healing elective: an opportunity to improve medical education curriculum to better manage the increasing burden of chronic wounds. Dermatology online journal 2019. link 17 Hesseler MJ, Shyam N. Platelet-rich plasma and its utility in medical dermatology: A systematic review. Journal of the American Academy of Dermatology 2019. link 18 Reyzelman AM, Vartivarian M, Danilkovitch A, Saunders MC. A Prospective, Single-center, Open-label Case Series Evaluating the Clinical Outcomes of Lyopreserved Placental Membrane Containing Viable Cells in the Treatment of Chronic Wounds. Wounds : a compendium of clinical research and practice 2019. link 19 Fitzpatrick E, Holland OJ, Vanderlelie JJ. Ozone therapy for the treatment of chronic wounds: A systematic review. International wound journal 2018. link 20 Gupta S, Andersen C, Black J, de Leon J, Fife C, Lantis Ii JC et al.. Management of Chronic Wounds: Diagnosis, Preparation, Treatment, and Follow-up. Wounds : a compendium of clinical research and practice 2017. link 21 Parkinson LA, van Zanten M, Piller N, Arkwright JW. A high-resolution tape sensor improves the accuracy of applied pressure profiles during lower-leg bandaging - results from a study using a fibre-optic sensing tape. International wound journal 2017. link 22 Serena T, Connell H, McConnell S, Patel K, Doner B, Sabo M et al.. Novel Multivalent Wound-Healing Ointment Provides Bioburden Control and Moisture Management: A Retrospective Registry Data Analysis. Advances in skin & wound care 2016. link 23 Andrade SM, Santos IC. Hyperbaric oxygen therapy for wound care. Revista gaucha de enfermagem 2016. link 24 Molnar JA, Vlad LG, Gumus T. Nutrition and Chronic Wounds: Improving Clinical Outcomes. Plastic and reconstructive surgery 2016. link 25 Noizet M, Lagoutte E, Gratigny M, Bouschbacher M, Lazareth I, Roest Crollius H et al.. Master regulators in primary skin fibroblast fate reprogramming in a human ex vivo model of chronic wounds. Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society 2016. link 26 Oliveira FP, Oliveira BG, Santana RF, Silva Bde P, Candido Jde S. Nursing interventions and outcomes classifications in patients with wounds: cross-mapping. Revista gaucha de enfermagem 2016. link 27 Zhou K, Jia P. Depressive symptoms in patients with wounds: A cross-sectional study. Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society 2016. link 28 Shaharudin A, Aziz Z. Effectiveness of hyaluronic acid and its derivatives on chronic wounds: a systematic review. Journal of wound care 2016. link 29 Martinez-Zapata MJ, Martí-Carvajal AJ, Solà I, Expósito JA, Bolíbar I, Rodríguez L et al.. Autologous platelet-rich plasma for treating chronic wounds. The Cochrane database of systematic reviews 2016. link 30 Greenhalgh DG. Management of the skin and soft tissue in the geriatric surgical patient. The Surgical clinics of North America 2015. link 31 Kranke P, Bennett MH, Martyn-St James M, Schnabel A, Debus SE, Weibel S. Hyperbaric oxygen therapy for chronic wounds. The Cochrane database of systematic reviews 2015. link 32 Sonnad SS, Goldsack JC, Mohr P, Tunis S. Methodological recommendations for comparative research on the treatment of chronic wounds. Journal of wound care 2013. link 33 Martinez-Zapata MJ, Martí-Carvajal AJ, Solà I, Expósito JA, Bolíbar I, Rodríguez L et al.. Autologous platelet-rich plasma for treating chronic wounds. The Cochrane database of systematic reviews 2012. link 34 Lawall H. Treatment of chronic wounds. VASA. Zeitschrift fur Gefasskrankheiten 2012. link 35 Carter MJ, Fylling CP, Li WW, de Leon J, Driver VR, Serena TE et al.. Analysis of run-in and treatment data in a wound outcomes registry: clinical impact of topical platelet-rich plasma gel on healing trajectory. International wound journal 2011. link 36 Wojcik A, Atkins M, Mager DR. Dietary intake in clients with chronic wounds. Canadian journal of dietetic practice and research : a publication of Dietitians of Canada = Revue canadienne de la pratique et de la recherche en dietetique : une publication des Dietetistes du Canada 2011. link 37 Upton Z, Wallace HJ, Shooter GK, van Lonkhuyzen DR, Yeoh-Ellerton S, Rayment EA et al.. Human pilot studies reveal the potential of a vitronectin: growth factor complex as a treatment for chronic wounds. International wound journal 2011. link 38 Dieckmann C, Renner R, Milkova L, Simon JC. Regenerative medicine in dermatology: biomaterials, tissue engineering, stem cells, gene transfer and beyond. Experimental dermatology 2010. link 39 Wolcott RD, Rhoads DD, Bennett ME, Wolcott BM, Gogokhia L, Costerton JW et al.. Chronic wounds and the medical biofilm paradigm. Journal of wound care 2010. link 40 Kirsner RS. Biological agents for chronic wounds. American journal of clinical dermatology 2010. link 41 Chrisman CA. Care of chronic wounds in palliative care and end-of-life patients. International wound journal 2010. link 42 Wolcott RD, Cox SB, Dowd SE. Healing and healing rates of chronic wounds in the age of molecular pathogen diagnostics. Journal of wound care 2010. link 43 Letizia M, Uebelhor J, Paddack E. Providing palliative care to seriously ill patients with nonhealing wounds. Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society 2010. link 44 Lademann J, Richter H, Alborova A, Humme D, Patzelt A, Kramer A et al.. Risk assessment of the application of a plasma jet in dermatology. Journal of biomedical optics 2009. link 45 Chadwick P, Acton C. The use of amelogenin protein in the treatment of hard-to-heal wounds. British journal of nursing (Mark Allen Publishing) 2009. link 46 Langer A, Rogowski W. Systematic review of economic evaluations of human cell-derived wound care products for the treatment of venous leg and diabetic foot ulcers. BMC health services research 2009. link 47 Maida V, Ennis M, Kuziemsky C. The Toronto Symptom Assessment System for Wounds: a new clinical and research tool. Advances in skin & wound care 2009. link 48 Posnett J, Franks PJ. The burden of chronic wounds in the UK. Nursing times 2008. link 49 Alvarez OM, Kalinski C, Nusbaum J, Hernandez L, Pappous E, Kyriannis C et al.. Incorporating wound healing strategies to improve palliation (symptom management) in patients with chronic wounds. Journal of palliative medicine 2007. link 50 Jones KR, Fennie K, Lenihan A. Evidence-based management of chronic wounds. Advances in skin & wound care 2007. link 51 Roeckl-Wiedmann I, Bennett M, Kranke P. Systematic review of hyperbaric oxygen in the management of chronic wounds. The British journal of surgery 2005. link 52 Gottrup F. A specialized wound-healing center concept: importance of a multidisciplinary department structure and surgical treatment facilities in the treatment of chronic wounds. American journal of surgery 2004. link00303-9) 53 Kranke P, Bennett M, Roeckl-Wiedmann I, Debus S. Hyperbaric oxygen therapy for chronic wounds. The Cochrane database of systematic reviews 2004. link 54 Mostow EN. Wound healing: a multidisciplinary approach for dermatologists. Dermatologic clinics 2003. link00100-6) 55 Falanga V. Wound healing and chronic wounds. Journal of cutaneous medicine and surgery 1998. link 56 Nordberg M. Young guns. Emergency medical services 1992. link

    Original source

    1. [1]
      Assessment and management of chronic venous, arterial, and diabetic wounds in older adults. — Dowling C, Chu L, Etkin Y, Oropallo A Seminars in vascular surgery (2025)
    2. [2]
      Chronic Wounds and Dressings: An Overview of Management and Effectiveness. — Sengul T, Kirkland-Kyhn H, Karadag A The Nursing clinics of North America (2025)
    3. [3]
      The overlooked epidemic: the importance of treating 'other' open wounds in wound medicine. — Carpenter S, Lantis J, Ferguson A Journal of wound care (2025)
    4. [4]
      Holy Medicine: Patron Saints of Wounds Due to Animal Bites. — Chomentowska E, Polak A, Grzybowski A Skinmed (2024)
    5. [5]
      Assessment of Wound-Related Pain Experiences of Patients With Chronic Wounds: A Multicenter Cross-Sectional Study in Eastern China. — Wei M, Zheng H, Xu X, Ji Y, Yu X, Lu L et al. Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society (2024)
    6. [6]
      Impact of oral nutritional supplement composition on healing of different chronic wounds: A systematic review. — Santo ACSDE, Sugizaki CSA, de Morais Junior AC, Costa NA, Bachion MM, Mota JF Nutrition (Burbank, Los Angeles County, Calif.) (2024)
    7. [7]
      Is Shock Wave Application Effective on Various Chronic Wounds in the Geriatric Population? Preliminary Clinical Study. — Dymarek R, Kuberka I, Walewicz K, Taradaj J, Rosińczuk J, Sopel M Clinical interventions in aging (2024)
    8. [8]
      Unique Usages of Dehydrated Human Amnion Chorion Membrane Allografts in Dermatology. — Garcia N, Jiminez V, Graham L, Huang C Journal of drugs in dermatology : JDD (2023)
    9. [9]
      The efficacy of low-frequency ultrasound as an added treatment for chronic wounds: A meta-analysis. — Chen H, Yu Z, Liu N, Huang J, Liang X, Liang X et al. International wound journal (2023)
    10. [10]
      Chronic wound prevalence and the associated cost of treatment in Medicare beneficiaries: changes between 2014 and 2019. — Carter MJ, DaVanzo J, Haught R, Nusgart M, Cartwright D, Fife CE Journal of medical economics (2023)
    11. [11]
      Correlation between vitamin D levels and hard-to-heal wounds: a systematic review. — Smith K, Hewlings S Journal of wound care (2021)
    12. [12]
      Implementing a Locally Made Low-Cost Intervention for Wound and Lymphedema Care in Western Kenya. — Chang AY, Mungai M, Coates SJ, Chao T, Odhiambo HP, Were PM et al. Dermatologic clinics (2021)
    13. [13]
      Prevention, Diagnosis, and Management of Chronic Wounds in Older Adults. — Hoversten KP, Kiemele LJ, Stolp AM, Takahashi PY, Verdoorn BP Mayo Clinic proceedings (2020)
    14. [14]
      Chronic Wounds: Evaluation and Management. — Bowers S, Franco E American family physician (2020)
    15. [15]
      Efficacy of MMP-inhibiting wound dressings in the treatment of chronic wounds: a systematic review. — Dissemond J, Augustin M, Dietlein M, Faust U, Keuthage W, Lobmann R et al. Journal of wound care (2020)
    16. [16]
      Wound healing elective: an opportunity to improve medical education curriculum to better manage the increasing burden of chronic wounds. — Kamath P, Agarwal N, Salgado CJ, Kirsner R Dermatology online journal (2019)
    17. [17]
      Platelet-rich plasma and its utility in medical dermatology: A systematic review. — Hesseler MJ, Shyam N Journal of the American Academy of Dermatology (2019)
    18. [18]
      A Prospective, Single-center, Open-label Case Series Evaluating the Clinical Outcomes of Lyopreserved Placental Membrane Containing Viable Cells in the Treatment of Chronic Wounds. — Reyzelman AM, Vartivarian M, Danilkovitch A, Saunders MC Wounds : a compendium of clinical research and practice (2019)
    19. [19]
      Ozone therapy for the treatment of chronic wounds: A systematic review. — Fitzpatrick E, Holland OJ, Vanderlelie JJ International wound journal (2018)
    20. [20]
      Management of Chronic Wounds: Diagnosis, Preparation, Treatment, and Follow-up. — Gupta S, Andersen C, Black J, de Leon J, Fife C, Lantis Ii JC et al. Wounds : a compendium of clinical research and practice (2017)
    21. [21]
      A high-resolution tape sensor improves the accuracy of applied pressure profiles during lower-leg bandaging - results from a study using a fibre-optic sensing tape. — Parkinson LA, van Zanten M, Piller N, Arkwright JW International wound journal (2017)
    22. [22]
      Novel Multivalent Wound-Healing Ointment Provides Bioburden Control and Moisture Management: A Retrospective Registry Data Analysis. — Serena T, Connell H, McConnell S, Patel K, Doner B, Sabo M et al. Advances in skin & wound care (2016)
    23. [23]
      Hyperbaric oxygen therapy for wound care. — Andrade SM, Santos IC Revista gaucha de enfermagem (2016)
    24. [24]
      Nutrition and Chronic Wounds: Improving Clinical Outcomes. — Molnar JA, Vlad LG, Gumus T Plastic and reconstructive surgery (2016)
    25. [25]
      Master regulators in primary skin fibroblast fate reprogramming in a human ex vivo model of chronic wounds. — Noizet M, Lagoutte E, Gratigny M, Bouschbacher M, Lazareth I, Roest Crollius H et al. Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society (2016)
    26. [26]
      Nursing interventions and outcomes classifications in patients with wounds: cross-mapping. — Oliveira FP, Oliveira BG, Santana RF, Silva Bde P, Candido Jde S Revista gaucha de enfermagem (2016)
    27. [27]
      Depressive symptoms in patients with wounds: A cross-sectional study. — Zhou K, Jia P Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society (2016)
    28. [28]
      Effectiveness of hyaluronic acid and its derivatives on chronic wounds: a systematic review. — Shaharudin A, Aziz Z Journal of wound care (2016)
    29. [29]
      Autologous platelet-rich plasma for treating chronic wounds. — Martinez-Zapata MJ, Martí-Carvajal AJ, Solà I, Expósito JA, Bolíbar I, Rodríguez L et al. The Cochrane database of systematic reviews (2016)
    30. [30]
      Management of the skin and soft tissue in the geriatric surgical patient. — Greenhalgh DG The Surgical clinics of North America (2015)
    31. [31]
      Hyperbaric oxygen therapy for chronic wounds. — Kranke P, Bennett MH, Martyn-St James M, Schnabel A, Debus SE, Weibel S The Cochrane database of systematic reviews (2015)
    32. [32]
      Methodological recommendations for comparative research on the treatment of chronic wounds. — Sonnad SS, Goldsack JC, Mohr P, Tunis S Journal of wound care (2013)
    33. [33]
      Autologous platelet-rich plasma for treating chronic wounds. — Martinez-Zapata MJ, Martí-Carvajal AJ, Solà I, Expósito JA, Bolíbar I, Rodríguez L et al. The Cochrane database of systematic reviews (2012)
    34. [34]
      Treatment of chronic wounds. — Lawall H VASA. Zeitschrift fur Gefasskrankheiten (2012)
    35. [35]
      Analysis of run-in and treatment data in a wound outcomes registry: clinical impact of topical platelet-rich plasma gel on healing trajectory. — Carter MJ, Fylling CP, Li WW, de Leon J, Driver VR, Serena TE et al. International wound journal (2011)
    36. [36]
      Dietary intake in clients with chronic wounds. — Wojcik A, Atkins M, Mager DR Canadian journal of dietetic practice and research : a publication of Dietitians of Canada = Revue canadienne de la pratique et de la recherche en dietetique : une publication des Dietetistes du Canada (2011)
    37. [37]
      Human pilot studies reveal the potential of a vitronectin: growth factor complex as a treatment for chronic wounds. — Upton Z, Wallace HJ, Shooter GK, van Lonkhuyzen DR, Yeoh-Ellerton S, Rayment EA et al. International wound journal (2011)
    38. [38]
      Regenerative medicine in dermatology: biomaterials, tissue engineering, stem cells, gene transfer and beyond. — Dieckmann C, Renner R, Milkova L, Simon JC Experimental dermatology (2010)
    39. [39]
      Chronic wounds and the medical biofilm paradigm. — Wolcott RD, Rhoads DD, Bennett ME, Wolcott BM, Gogokhia L, Costerton JW et al. Journal of wound care (2010)
    40. [40]
      Biological agents for chronic wounds. — Kirsner RS American journal of clinical dermatology (2010)
    41. [41]
      Care of chronic wounds in palliative care and end-of-life patients. — Chrisman CA International wound journal (2010)
    42. [42]
      Healing and healing rates of chronic wounds in the age of molecular pathogen diagnostics. — Wolcott RD, Cox SB, Dowd SE Journal of wound care (2010)
    43. [43]
      Providing palliative care to seriously ill patients with nonhealing wounds. — Letizia M, Uebelhor J, Paddack E Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society (2010)
    44. [44]
      Risk assessment of the application of a plasma jet in dermatology. — Lademann J, Richter H, Alborova A, Humme D, Patzelt A, Kramer A et al. Journal of biomedical optics (2009)
    45. [45]
      The use of amelogenin protein in the treatment of hard-to-heal wounds. — Chadwick P, Acton C British journal of nursing (Mark Allen Publishing) (2009)
    46. [46]
      Systematic review of economic evaluations of human cell-derived wound care products for the treatment of venous leg and diabetic foot ulcers. — Langer A, Rogowski W BMC health services research (2009)
    47. [47]
      The Toronto Symptom Assessment System for Wounds: a new clinical and research tool. — Maida V, Ennis M, Kuziemsky C Advances in skin & wound care (2009)
    48. [48]
      The burden of chronic wounds in the UK. — Posnett J, Franks PJ Nursing times (2008)
    49. [49]
      Incorporating wound healing strategies to improve palliation (symptom management) in patients with chronic wounds. — Alvarez OM, Kalinski C, Nusbaum J, Hernandez L, Pappous E, Kyriannis C et al. Journal of palliative medicine (2007)
    50. [50]
      Evidence-based management of chronic wounds. — Jones KR, Fennie K, Lenihan A Advances in skin & wound care (2007)
    51. [51]
      Systematic review of hyperbaric oxygen in the management of chronic wounds. — Roeckl-Wiedmann I, Bennett M, Kranke P The British journal of surgery (2005)
    52. [52]
      A specialized wound-healing center concept: importance of a multidisciplinary department structure and surgical treatment facilities in the treatment of chronic wounds. — Gottrup F American journal of surgery (2004)
    53. [53]
      Hyperbaric oxygen therapy for chronic wounds. — Kranke P, Bennett M, Roeckl-Wiedmann I, Debus S The Cochrane database of systematic reviews (2004)
    54. [54]
      Wound healing: a multidisciplinary approach for dermatologists. — Mostow EN Dermatologic clinics (2003)
    55. [55]
      Wound healing and chronic wounds. — Falanga V Journal of cutaneous medicine and surgery (1998)
    56. [56]
      Young guns. — Nordberg M Emergency medical services (1992)
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