arthrex speedbridge complications

The technique is though without doubt more involved than simply using a postero-lateral or postero-medial approach and fixing the tendon back with a Bio-corkscrew anchor, which covered on OrthOracle at Haglunds deformity: Arthrex Bio-corkscrew fixation and a postero-lateral approach.Generally the surgery is easier performed with the patient prone but as this technique demonstrates it cab be done with the patient well supported in a lateral position. /FontFile2 89 0 R 2023 | Phen HM, Manz WJ, Mignemi D, Greenshields JT, Bariteau JT. J-STAGE, Japan Science and Technology Information Aggregator, Electronic. A free FiberTape (Arthrex) is then loaded within the eyelet of a 4.75-mm double-loaded Bio-SwiveLock anchor (Arthrex) and inserted with the aid of a mallet into the predrilled socket (Fig 2). /Type /Font Review of Achilles Tendon Reattachment Using Double-Row Knotted and Knotless Techniques in the Management of Insertional Achilles Tendinopathy. Accessibility im sure i did not have what you described. My understanding is that your PARS procedure and the Speedbridge are actually not that different. 2022 Sep-Oct;61(5):927-931. doi: 10.1053/j.jfas.2021.12.015. Before The Arthrex SpeedBridge repair is a surgical technique system that combines fully threaded SwiveLock anchors with FiberTape suture. Update: 6/13/2018 Dr. visit today. The site is secure. Surgical management of insertional Achilles tendinosis includes Achilles tendon debridement, calcaneal exostosis ostectomy, and retrocalcaneal bursa excision. /Rotate 0 Both procedures are pretty brilliant from a simplicity and effectiveness standpoint. If the wound was completely healed my surgeon assured me I could be walking without the boot. See this link - https://www.arthrex.com/foot-ankle/pars-achilles-jig-system. 0000002257 00000 n Incisions are minimal, relatively speaking, so the pain was not bad. 8600 Rockville Pike << >> Insertional Achilles tendinosis is a degenerative process of the tendon at the junction of the tendon and calcaneus. /Root 85 0 R While standard anchor fixation of the tendon creates only a single point of compression directly over the anchor, the SpeedBridge repair enables an hourglass pattern of FiberTape suture to be laid over the distal end of the tendon. Please enable it to take advantage of the complete set of features! HHS Vulnerability Disclosure, Help The https:// ensures that you are connecting to the While standard anchor fixation of the tendon creates only a single point of compression directly over the anchor, the SpeedBridge repair enables an hourglass pattern of FiberTape suture to be laid over the distal end of 2013 Sep-Oct;52(5):575-9. doi: 10.1053/j.jfas.2012.11.004. PMC [Application of percutaneous transcalcaneal reconstruction technique for acute Achilles tendon insertion avulsion]. Achilles Midsubstance SpeedBridge Implant System, Achilles SpeedBridge Repair Implant System, The Arthrex SpeedBridge repair is an innovative soft-tissue fixation device used in the treatment of Achilles injuries. Non-operative treatment is somewhat less successful when adopted here than for problems with the main body of the achilles tendon. MeSH To prove you're a person (not a spam script), type the security word shown in the picture. endobj PMC Once the socket has been created, a 4.5-mm Corkscrew tap (Arthrex) is used to ensure ease of anchor insertion in the dense bone. endobj /Length1 40964 Curious if others have undergone this specific procedure and how they are doing. National Library of Medicine I am surprised there is not more discussion about it here. /Widths 90 0 R /FontDescriptor 88 0 R While standard anchor fixation of the tendon creates only a single point of compression directly over the anchor, the SutureBridge enables an hourglass pattern of FiberWire suture to be laid over the distal end of the tendon. Again, very little swelling and no pain. /Linearized 1 PMC 4.75 mm BioComposite SpeedBridge Implant System w/SCORPION-Multifire Needle Includes two 4.75 mm BioComposite SwiveLock C Anchors w/one Preloaded FiberTape Loop (1 Blue, 1 White/Black) for Medial Row, two 4.75 BioComposite SwiveLock Anchors for Lateral Row, Disposable Punch, and SCORPION-Multifire Needle. The Speedbridge provides a far more robust level of fixation for the achilles than any alternatives. % Im in my thirties, male, and active, so Dr. said surgery was the way to go and he mainly uses the PARS Speedbridge method. government site. Int J Surg Case Rep. 2022 Jul;96:107355. doi: 10.1016/j.ijscr.2022.107355. /BaseFont /ACHMZE+Calibri Of course, the tendon was and is still super tight so I am limping a bit while I work on loosening up the tendon and strengthening. It should be remembered however that of greater importance is identifying the various potential sources of symptoms and treating them all. Treatment of Calcific Insertional Achilles Tendinopathy: Knotless Internal Brace versus Knot-Tying Suture Bridge. Please enable it to take advantage of the complete set of features! Lewis TL, Srirangarajan T, Patel A, Yip GCK, Hussain L, Walker R, Singh S, Latif A, Abbasian A. Eur J Orthop Surg Traumatol. This avoids a lot of scar tissue and potential nerve damage and allows the tendon to heal naturally. The key is to identify the exact location and nature of the pathology causing symptoms. 88 0 obj 0000039227 00000 n This hourglass pattern of FiberWire() provides a greater area of tendon compression, consequently allowing greater stability and possible earlier return to weightbearing activities. Would you like email updates of new search results. << Disclaimer. Thank you to all who contribute. and transmitted securely. My main minimal concern or curiousity was with the heel anchors - what if it gets loose over time or heel pain in the future? Would you like email updates of new search results? Are there other Speedbridgers out there? There were no intraoperative or postoperative complications. /Encoding /WinAnsiEncoding Usually the painful area is located laterally but it can on occasion be postero-medial. 0000001012 00000 n << Arthrex develops and releases more than 1,000 new products and procedures every year to advance minimally invasive orthopedics worldwide. I feel like I could return sooner, but want to be careful as well. /StructParents 0 I am just so happy to be able to make a cup of tea AND carry it to the couch, that Im enjoying this milestone that gave me back some independence! I am went to 2 shoes FWB at 7 weeks without problem. There may or may not be an element of anatomical prominence of the postero-lateral calcaneus associated. One can be as extensive as required therefore with the level of dissection. This . Institution: The Wellington Hospital, London, UK. Very small incision, shorter surgery, and fewer complications. The Arthrex SutureBridge() (Arthrex, Inc., Naples, FL) device uses a series of 4 suture anchors and FiberWire() (Arthrex Inc.) to reattach the Achilles tendon to its calcaneal insertion. Continue to more PT, but watch the wound and make sure healed before running and strenuous exercise. The surgeon may use the SpeedBridge for repair of a. /O 86 /StemV 52 i had a mini-open surgery but that is all i know about the procedure itself. /FontName /ACHMZE+Calibri /CapHeight 750 0000055855 00000 n /T 203780 We have earned our reputation of being one of the most trusted and credible writing services by working extremely hard to constantly improve our standard. Best Writer Reviews Provider is helping students especially in usa in getting brilliant quality reviews writing USA, essays and dissertations. Would you like email updates of new search results? Hi all, I suffered a full rupture (4cm above heel; 2-3 cm apart) that Dr said was fairly standard. Anti-spam word: (Required)* /Ascent 750 My doc used the speedbridge on for my surgery as well. 0000001432 00000 n Journal of Foot and Ankle Surgery. Before The .gov means its official. 2013 Oct;126(20):3860-4. https://www.arthrex.com/foot-ankle/achilles-midsubstance-speedbridge-repair, https://m.arthrex.com/resources/presentation/wREBpyd-_UGyRwFgvCaP4Q/achilles-midsubstance-speedbridge-repair, https://www.arthrex.com/resources/videos-case-presentations/blJIThXB8kC9CwFZZaNyJg/achilles-midsubstance-surgical-repair-using-the-achilles-midsubstance-speedbridge-system. Clinicians should seek clarification on whether any implant demonstrated is licensed for use in their own country. 2023 Feb 24;13(3):404. doi: 10.3390/jpm13030404. /Length 329 /N 11 >> An official website of the United States government. Disclaimer. 1 Reference 1. << Disclaimer. /Type /FontDescriptor The benefit of this surgery is that it is minimally invasive, very low risk of nerve injury, very strong, and has no knots that can come apart. stream While standard anchor fixation of the tendon creates only a single point of compression directly over the anchor, the SutureBridge enables an hourglass pattern of FiberWire suture to be laid over the distal end of the tendon. Our e-learning platform contains high resolution images and a certified CME of the Achilles tendon: Haglunds deformity, central approach using Arthrex Speedbridge surgical procedure. sharing sensitive information, make sure youre on a federal How long did it take you to walk in two shoes ? official website and that any information you provide is encrypted /S 486 Foot Ankle Orthop. Lin Y, Wang ZW, Zhang B, Pan J, Qu TB, Hai Y. Chin Med J (Engl). Recently, a limited-incision knotless Achilles tendon repair technique (Achilles Midsubstance SpeedBridge; Arthrex) was developed to minimize soft-tissue dissection, restore musculotendinous length, and directly fix tendon to bone to allow for early mobilization and more rapid functional recovery. sharing sensitive information, make sure youre on a federal FOIA Site by Redwire. This will assist in deciding upon the surgical approach to be taken. These cases should be imaged using cross sectional imaging to determine the location of both bony deformity and tendinopathy. official website and that any information you provide is encrypted Invest. For more information, visit https://www.arthrex.com- - - - -OrthoPedia is an innovative educational website that was created for anyone interested in learning about orthopedics from the first-year student to the experienced orthopedic surgeon. All patients underwent reattachment of the Achilles tendon with the suture bridge technique. /LastChar 121 2022 Apr 15;36(4):415-419. doi: 10.7507/1002-1892.202111089. Medical Device Company Arthrex to Pay $16 Million to Resolve Kickback Allegations Arthrex Inc., a Florida-based medical device company, has agreed to resolve allegations that it violated the False Claims Act by paying kickbacks that caused the submission of false claims to the Medicare program. The suture bridge technique was effective for the reconstruction of the Achilles tendon in an obese and athletic patient. The Arthrex SpeedBridge repair is an innovative soft-tissue fixation device used in the treatment of Achilles injuries. Published by Elsevier Inc. All rights reserved. /Filter /FlateDecode 100 0 R /X1 101 0 R >> >> I got pretty good at power hobbling with my boot on while I was waiting though! The third variation is a calcaneus that is anatomically prominent posteriorly, laterally and also superiorly. 2013;52 (5):575-579. doi:10.1053/j.jfas.2012.11.004. Acute midsubstance Achilles tendon ruptures, which are increasingly common among athletes, can result in significant functional limitations and decreased quality of life when not managed appropriately. I similarly went from PWB to FWB within a few days. While standard anchor fixation of the tendon creates only a single point of compression directly over the anchor, the SpeedBridge repair enables an hourglass pattern of FiberTape suture to be laid over the distal end of , While standard anchor fixation of the tendon creates only a single point of compression directly over the anchor, the SutureBridge enables an hourglass pattern of FiberWiresuture to be laid over the distal end of the tendon. 0000072739 00000 n he talked about sewing the ends together. An official website of the United States government. National Library of Medicine Posterior heel pain (retrocalcaneal bursitis, insertional and noninsertional Achilles tendinopathy). stream endobj 2005 Jan;22(1):19-43. doi: 10.1016/j.cpm.2004.08.003. xx\. went to 2 shoes full weight bearing no crutches. Bookshelf It took me 11 weeks to get to two shoes - the surgeon made me wait longer than normal because my rupture was at the top end of the tendon (muscle on one side, tendon on the other) and those take longer to heal. /Filter /FlateDecode A 48-year-old man presented to our department with a 6-month history of left posterior heel pain. The SutureBridge and SpeedBridge are novel concepts in Achilles reattachment, following debridement. The rotator cuff is what holds your upper arm bone in the shoulder socket and helps to lift and rotate your arm. Implant System, BioComposite Achilles SpeedBridge with JumpStart, Implant System, PEEK Achilles SpeedBridge with JumpStart, Implant System, BioComposite Achilles SpeedBridge, Implant System, PEEK Achilles SpeedBridge, Surgical Technique Videos | 11:20 | English | 09/06/2017 | VID1-0463-EN C, Surgical Technique Guides | English | 05/11/2020 | LT1-0463-EN F, Presentation Videos | 06:11 | English | 04/20/2018 | VID1-01195-EN C, Surgical Technique Animations | 02:33 | English | 05/21/2015 | AN1-0463-EN B, Case Presentation Videos | 05:13 | English | 08/08/2017 | VPT1-00877-EN B, Surgical Technique Videos | 04:59 | English | 10/11/2019 | VID1-000654-en-US A, 05:17 | English | 12/28/2020 | VID1-000182-en-US C, 04:59 | English | 10/11/2019 | VID1-000654-en-US A, 11:20 | English | 09/06/2017 | VID1-0463-EN C, 09:27 | English | 08/28/2015 | VID1-00438-EN A, 37:06 | English | 12/18/2012 | VID1-0466-EN A, 02:33 | English | 05/21/2015 | AN1-0463-EN B, 05:59 | English | 12/16/2019 | VID1-000260-en-US A, 05:13 | English | 08/08/2017 | VPT1-00877-EN B, 02:36 | English | 03/15/2017 | PAN1-0463-EN D, 09:30 | English | 08/02/2018 | VID1-01364-EN A, 13:03 | English | 05/30/2018 | VPT1-01038-EN A, 06:11 | English | 04/20/2018 | VID1-01195-EN C, 06:28 | English | 06/13/2022 | VID1-003096-en-US A, English | 05/04/2021 | LN1-000324-en-US A, 06:06 | English | 08/26/2019 | VID1-000186-en-US A. /Group << /CS /DeviceRGB /S /Transparency /Type /Group >> /Pages 82 0 R /Prev 203769 The PARS jig pulls the broken ends of the tendon together using fiberwire, but there is no stitching the broken ends together like with an open traditional repair. I am walking now in the boot without a crutch fairly well. 4.75 mm BioComposite SpeedBridge Implant System Includes two 4.75 mm BioComposite SwiveLock C anchors w /one preloaded FiberTape Loop (1 Blue, 1 White/Black) for medial row, two 4.75 mm BioComposite SwiveLock C for lateral row, and disposable punch, 4.75/5.5 mm BioComposite SpeedBridge Implant System SP (self-punching) Includes two 4.75 mm BioComposite SwiveLock C anchors w/ one preloaded FiberTape Loop (1 blue, 1 white/black) for medial row, two 5.5 mm BioComposite SwiveLock SP (self-punching) anchors for lateral row, and disposable punch, 4.75 mm PEEK SpeedBridge Implant System Includes two 4.75 mm PEEK SwiveLock C anchors w/ one preloaded FiberTape Loop (1 Blue, 1 White/Black) for medial row, two 4.75 mm PEEK SwiveLock C anchors for lateral row, and disposable punch, 4.75/5.5 mm PEEK SpeedBridge Implant System SP (self-punching) Includes two 4.75 mm PEEK SwiveLock C anchors w/one preloaded FiberTape Loop (1 blue, 1 white/black) for medial row, two 5.5 mm PEEK SwiveLock SP (self-punching) anchors for lateral row, and disposable punch. >> 8600 Rockville Pike The .gov means its official. Subscribe to get full access to this operation and the extensive Foot Surgery Atlas. Arthrex Achilles Speedbridge Complications: None apparent. At 4 weeks I started PT and partial weight bearing. Great topic of discussion, really didnt know there was a couple different techniques being used. /L 205587 In the EU contact: ema.europa.eu. /Resources << /Font << /F1 87 0 R /F2 91 0 R /F3 95 0 R >> /XObject << /X0 Interval H&P was performed. Zhao X, Yang X, Hao Y, Yang F, Zhang Z, Qian Q, Fu P, Zhou Q. J Pers Med. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. >> In this case series, we present 4 patients who underwent surgical management of insertional Achilles tendinosis with complete tendon detachment. endstream /Descent -250 In my practice I use the Speedbridge for cases of insertional achilles tendinosis where there is significant intra-tendinous calcification that will require extensive detachment of the tendon for adequate access. >> My understanding is that your PARS procedure and the Speedbridge are actually not that different. 2016;63(3-4):310-4. doi: 10.2152/jmi.63.310. Efficacy of Achilles Suture Bridge Technique for Insertional Achilles Tendinosis in an Obese and Athletic Patient. 0000001984 00000 n The Arthrex SpeedBridge repair is an innovative soft-tissue fixation device used in the treatment of Achilles injuries. 63: 310-314, August, 2016. Bookshelf I had the PARS technique surgery last August - horizontal incision about 1.5 inches long, then a jig to pull the pieces together and stitch them up. These variations in pathology can be treated using the same surgical principles and with successful outcome expected in the majority of patients. /Type /Catalog An important albeit subjective aspect of Achilles tendon repair is suture knot tying and tensioning around the rupture site. Please try again, or try refreshing the page. 6 weeks, 5 days post ATR surgery. %%EOF The patient was an athlete (triathlon) and appeared obese (height: 197 cm, body weight: 120 kg, body mass index: 30.9). J Med Invest. Certain products may not be approved for sale in all countries. The indications, contraindications, details, pearls, and pitfalls of this surgical technique are discussed in this article. Sorry, got sidetracked there with the celebrating Procedure in Detail: Patient was visited in the pre-operative holding unit and correct site, correct patient identified. Its just that once I got used to the sensation of weight bearing, I felt virtually no difference between partial and full. << 0000039032 00000 n The surgery lasted 40 minutes, I have minimal scarring, very little post-surgery swelling, and no pain. The BioComposite SpeedBridge implant systems include 4.75 mm vented BioComposite SwiveLock anchors with preloaded FiberTape loops, which ease suture passage for the medial row, and 4.75 mm BioComposite SwiveLock C or 5.5 mm BioComposite SwiveLock SP (self-punching) anchors for the lateral row. Federal government websites often end in .gov or .mil. While standard anchor fixation of the tendon creates only a single point of compression directly over the anchor, the SpeedBridge repair enables an hourglass pattern of FiberTape, While standard anchor fixation of the tendon creates only a single point of compression directly over the anchor, the SutureBridge enables an hourglass pattern of FiberWire. /ItalicAngle 0 /Parent 82 0 R My surgeon tells me I am cleared to return to golf and other sports at 12 weeks. trailer The https:// ensures that you are connecting to the The Arthrex SpeedBridge implant itself is very much a really useful part of the surgical armamentarium available to treat Haglunds cases. I completely understand that the scariest steps are still ahead of me with wedge removal and eventual two shoes. Before 0000038620 00000 n Federal government websites often end in .gov or .mil. /Lang (en-GB) In the USA contact: fda.gov MeSH 0000048631 00000 n Bethesda, MD 20894, Web Policies I am new to this forum, and have read a lot of posts. The site is secure. Less commonly the achilles tendon is normal and the issue is an anatomical prominence of the postero-lateral corner of the calcaneus, causing pressure when in shoe-wear. It should be remembered however that of greater importance is identifying the various potential sources of symptoms and treating them all. Recently, a limited-incision knotless Achilles tendon repair technique (Achilles Midsubstance SpeedBridge; Arthrex) was developed to minimize soft-tissue dissection, restore musculotendinous length, and directly fix tendon to bone to allow for early mobilization and more rapid functional recovery. Thought I had read that its typically horizontal, but mine is vertical. This site needs JavaScript to work properly. There was an error retrieving the content. This four-anchor construct enables a true knotless repair and a greater area of compression for the Achilles tendon on the calcaneus, improving stability and possibly allowing for earlier return to normal activities. Materials for performing an Achilles tendon rip-stop SpeedBridge repair include intraoperative fluoroscopy and the Arthrex Achilles SpeedBridge (Naples, FL) implant system, which includes a 3.5-mm drill bit, drill guide, tap with AO quick connect, tap with handle, two 4.75-mm SwiveLock anchors with #2 FiberWire suture and FiberTape loop with Hi, this is a comment.To delete a comment, just log in, and view the posts comments, there you will have the option to edit or delete them. Dr. says no concerns that tendon will rupture but to be careful and use boot in airports, etc. This four-anchor construct enables a greater area of . I started pwb in the boot (3 wedges) with docs approval a few days ago. sharing sensitive information, make sure youre on a federal Materials for performing an Achilles tendon rip-stop SpeedBridge repair include intraoperative fluoroscopy and the Arthrex Achilles SpeedBridge (Naples, FL) implant system, which includes a 3.5-mm drill bit, drill guide, tap with AO quick connect, tap with handle, two 4.75-mm SwiveLock anchors with #2 FiberWire suture and FiberTape loop with Careers. /MaxWidth 1743 /Subtype /TrueType /E 72916 Six weeks postoperatively, this patient was allowed to walk with full weight bearing. startxref Visit https://www.orthopedia.com to experience the future of Medical Education. There are three main varities of pathology effecting the area of the achilles tendon insertion and to which the description of a Haglunds deformity is commonly(and loosely) applied. Clin Podiatr Med Surg. /FirstChar 32 After 3 to 6 months of conservative therapy has failed to alleviate symptoms, surgical management is indicated. xc```a``"z@ Y8>00014E0`c\;OL @*X,:5Jz77I,HL4Bl'+7RVndZipGpqJh:!`7A$iOn0d(Ol^U0x8#P -`i~UL%[>OPmhCJ3)#|X6p5(hI ~_%<8p*008403:h 1. /ID [<959befb3d145b1778f6396bf63680c5f><959befb3d145b1778f6396bf63680c5f>] /Annots [ 103 0 R 104 0 R ] The Arthrex SpeedBridge repair is a surgical technique system that combines fully threaded SwiveLock anchors with FiberTape suture. Clipboard, Search History, and several other advanced features are temporarily unavailable. I will update later to confirm that and my progress, but I already have good range of motion and feel like I could walk in shoes now. hi there - im 2w2d post op. Federal government websites often end in .gov or .mil. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Copyright 2012 American College of Foot and Ankle Surgeons. 85 0 obj 0000061233 00000 n 2 weeks post-surgery I had the splint case removed and bought the fancy Vacocast Vacoped achilles boot (totally worth the $300). Journal of Foot and Ankle Surgery. Please enable it to take advantage of the complete set of features! M,KtjXvY C [WORDPRESS HASHCASH] The poster sent us 0 which is not a hashcash value. /FontWeight 400 Accessibility Ill be talking to my doctor about that topic, which seems to be a very common discussion point in a lot of these forums. This 4-anchor construct enables a true knotless repair and a greater area of compression for the Achilles tendon on the calcaneus, improving stability such that immediate postoperative weightbearing and range of motion is possible. government site. Maybe it is not yet mainstream. 87 0 obj Bethesda, MD 20894, Web Policies Registered in England and Wales No. >> This will also on occasion show evidence of associated retro-calcaneal bursitis which should be intercurrently treated. Chronic insertional Achilles tendinopathy secondary to congenital os Achilles: A case report. I didnt even read my operating report until a year after the surgery when I found out thats what he used (and thats what he always uses if he can). He has been doing it for about a year on all fully torn achilles, including several professional athletes. /AvgWidth 521 All patients were able to return to their activities of daily living without the use of assistive devices. Open repair of acute Achilles tendon ruptures continues to remain controversial among surgeons as they weigh the tradeoffs of reduced re-rupture rates, improved calf strength, and increased return to activity against potential wound healing and infectious complications. This four-anchor construct enables a greater area of compression for the Achilles tendon on the calcaneus, , The SutureBridge and SpeedBridge are novel concepts in Achilles reattachment, following debridement. The Arthrex SutureBridge () (Arthrex, Inc., Naples, FL) device uses a series of 4 suture anchors and FiberWire () (Arthrex Inc.) to reattach the Achilles tendon to its calcaneal insertion. 2022. I did a lot of research and was very fortunate to find a surgeon in Florida doing the procedure. The incision is now almost healed (it is horizontal to the ground/across my leg), which is probably why it took awhile to heal since walking in the boot tends to pull at the incision. Achilles tendinopathy is divided into Achilles tendonitis and tendinosis based on histopathological examination. Wide detachment of the insertion of the Achilles tendon was necessary, and reattachment of the tendon was performed using the Arthrex SpeedBridge(TM) system (Arthrex, Inc., Naples, FL). I totally agree that minimally invasive is a good thing. 2023 May;33(4):1179-1184. doi: 10.1007/s00590-022-03270-7. HHS Vulnerability Disclosure, Help There is some great information. The soft tissue cover here is thin and prone to delayed healing. I also had the Speedbridge repair done. Havent been able to find much online from others, so I am glad I found this. Bethesda, MD 20894, Web Policies Overall though, sounds like people have had great success with it within the first year? 0000023081 00000 n Accessibility In the UK contact: gov.uk Unauthorized use of these marks is strictly prohibited. /MarkInfo << /Marked true >> Very small incision, shorter surgery, and fewer complications. FOIA /Type /Page %PDF-1.5 official website and that any information you provide is encrypted I am not trying to rush it and I dont feel like I have something to prove; rather quite the opposite, I am trying to follow directions like I never have before so I get through this with no complications if at all possible. dmv vision test chart california,

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