{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T13:17:27Z","timestamp":1791897447765,"version":"4.3.4"},"reference-count":55,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2022,4,1]],"date-time":"2022-04-01T00:00:00Z","timestamp":1648771200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Autologous fillet flaps are a common reconstructive option for large defects after forequarter amputation (FQA) due to advanced local malignancy or trauma. The inclusion of osseous structures into these has several advantages. This article therefore systematically reviews reconstructive options after FQA, using osteomusculocutaneous fillet flaps, with emphasis on personalized surgical technique and outcome. Additionally, we report on a case with an alternative surgical technique, which included targeted muscle reinnervation (TMR) of the flap. Our literature search was conducted in the PubMed and Cochrane databases. Studies that were identified were thoroughly scrutinized with regard to relevance, resulting in the inclusion of four studies (10 cases). FQA was predominantly a consequence of local malignancy. For vascular supply, the brachial artery was predominantly anastomosed to the subclavian artery and the brachial or cephalic vein to the subclavian or external jugular vein. Furthermore, we report on a case of a large osteosarcoma of the humerus. Extended FQA required the use of the forearm for defect coverage and shoulder contour reconstruction. Moreover, we performed TMR. Follow-up showed a satisfactory result and no phantom limb pain. In case of the need for free flap reconstruction after FQA, this review demonstrates the safety and advantage of osteomusculocutaneous fillet flaps. If the inclusion of the elbow joint into the flap is not possible, we recommend the use of the forearm, as described. Additionally, we advocate for the additional implementation of TMR, as it can be performed quickly and is likely to reduce phantom limb and neuroma pain.<\/jats:p>","DOI":"10.3390\/jpm12040560","type":"journal-article","created":{"date-parts":[[2022,4,1]],"date-time":"2022-04-01T21:23:55Z","timestamp":1648848235000},"page":"560","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Defect Coverage after Forequarter Amputation\u2014A Systematic Review Assessing Different Surgical Approaches"],"prefix":"10.3390","volume":"12","author":[{"given":"Denis","family":"Ehrl","sequence":"first","affiliation":[{"name":"Department of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Marchioninistra\u00dfe 15, 81377 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaus","family":"Wachtel","sequence":"additional","affiliation":[{"name":"Department of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Marchioninistra\u00dfe 15, 81377 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1267-0840","authenticated-orcid":false,"given":"David","family":"Braig","sequence":"additional","affiliation":[{"name":"Department of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Marchioninistra\u00dfe 15, 81377 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8102-1430","authenticated-orcid":false,"given":"Constanze","family":"Kuhlmann","sequence":"additional","affiliation":[{"name":"Department of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Marchioninistra\u00dfe 15, 81377 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1347-1173","authenticated-orcid":false,"given":"Hans Roland","family":"D\u00fcrr","sequence":"additional","affiliation":[{"name":"Orthopaedic Oncology, Department of Orthopaedics and Trauma Surgery, University Hospital, LMU Munich, Marchioninistra\u00dfe 15, 81377 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian P.","family":"Schneider","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, University Hospital, LMU Munich, Marchioninistra\u00dfe 15, 81377 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riccardo E.","family":"Giunta","sequence":"additional","affiliation":[{"name":"Department of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Marchioninistra\u00dfe 15, 81377 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,4,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3029","DOI":"10.1200\/JCO.2014.59.4895","article-title":"Osteosarcoma: Current Treatment and a Collaborative Pathway to Success","volume":"33","author":"Isakoff","year":"2015","journal-title":"J. Clin. Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1007\/BF00212181","article-title":"The \u201cEpaulette\u201d Flap: Replantation of Osteomyocutaneous Forearm Segments in Interscapulothoracic Amputations","volume":"15","author":"Steinau","year":"1992","journal-title":"Eur. J. Plast. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.tcr.2018.11.013","article-title":"Open Traumatic Scapulothoracic Dissociation: Case Report of a Rare Injury","volume":"18","author":"Anbarasan","year":"2018","journal-title":"Trauma Case Rep."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1002\/jso.1079","article-title":"Palliative Forequarter Amputation for Metastatic Carcinoma to the Shoulder Girdle Region: Indications, Preoperative Evaluation, Surgical Technique, and Results","volume":"77","author":"Wittig","year":"2001","journal-title":"J. Surg. Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1080\/23320885.2019.1666718","article-title":"The Forearm Fillet Flap: \u2018Spare Parts\u2019 Reconstruction for Forequarter Amputations","volume":"6","author":"Ayyala","year":"2019","journal-title":"Case Rep. Plast. Surg. Hand Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1097\/00000637-199804000-00012","article-title":"The Total Volar Forearm Musculocutaneous Free Flap for Reconstruction of Extended Forequarter Amputations","volume":"40","author":"Cordeiro","year":"1998","journal-title":"Ann. Plast. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1097\/SAP.0000000000002204","article-title":"Forequarter Amputation and Reconstructive Options","volume":"84","author":"Tukiainen","year":"2020","journal-title":"Ann. Plast. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1016\/j.jhsa.2018.03.053","article-title":"Current Concepts in Upper-Extremity Amputation","volume":"43","author":"Pierrie","year":"2018","journal-title":"J. Hand Surg. Am."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1002\/jso.25256","article-title":"Targeted Muscle Reinnervation and Prosthetic Rehabilitation after Limb Loss","volume":"118","author":"Mioton","year":"2018","journal-title":"J. Surg. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1097\/PRS.0000000000005133","article-title":"Targeted Muscle Reinnervation Technique in Below-Knee Amputation","volume":"143","author":"Bowen","year":"2019","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1089\/wound.2016.0717","article-title":"Targeted Muscle Reinnervation to Improve Pain, Prosthetic Tolerance, and Bioprosthetic Outcomes in the Amputee","volume":"6","author":"Bowen","year":"2017","journal-title":"Adv. Wound Care"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1055\/s-0035-1544166","article-title":"Targeted Muscle Reinnervation and Advanced Prosthetic Arms","volume":"29","author":"Cheesborough","year":"2015","journal-title":"Semin. Plast. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"884.e1","DOI":"10.1016\/j.jhsa.2019.10.020","article-title":"Targeted Muscle Reinnervation in the Hand: Treatment and Prevention of Pain After Ray Amputation","volume":"45","author":"Elmaraghi","year":"2019","journal-title":"J. Hand Surg. Am."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"264","DOI":"10.7326\/0003-4819-151-4-200908180-00135","article-title":"Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement","volume":"151","author":"Moher","year":"2009","journal-title":"Ann. Intern. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1097\/00006534-200109150-00011","article-title":"The Concept of Fillet Flaps: Classification, Indications, and Analysis of Their Clinical Value","volume":"108","author":"Erdmann","year":"2001","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1007\/BF02303573","article-title":"Radical Forequarter Amputation with Hemithoracectomy and Free Extended Forearm Flap: Technical and Physiologic Considerations","volume":"1","author":"Kuhn","year":"1994","journal-title":"Ann. Surg. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/j.bjps.2004.10.010","article-title":"Improved Shoulder Contour Following Forequarter Amputation with an Osteomyocutaneous Free Flap from the Amputated Extremity: Two Cases","volume":"58","author":"Osanai","year":"2005","journal-title":"Br. J. Plast. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.bjps.2013.10.040","article-title":"Shoulder Silhouette and Axilla Reconstruction with Free Composite Elbow Tissue Transfer Following Interscapulothoracic Amputation","volume":"67","author":"Koulaxouzidis","year":"2014","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2279","DOI":"10.1200\/JCO.2014.60.0734","article-title":"Methotrexate, Doxorubicin, and Cisplatin (MAP) plus Maintenance Pegylated Interferon Alfa-2b versus MAP Alone in Patients with Resectable High-Grade Osteosarcoma and Good Histologic Response to Preoperative MAP: First Results of the EURAMOS-1 Good Respons","volume":"33","author":"Bielack","year":"2015","journal-title":"J. Clin. Oncol."},{"key":"ref_20","first-page":"573","article-title":"International Collaboration Is Feasible in Trials for Rare Conditions: The EURAMOS Experience","volume":"152","author":"Marina","year":"2009","journal-title":"Cancer Treat. Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1007\/s00104-011-2124-6","article-title":"Weichgewebssarkome Der Oberen Extremit\u00e4t: Analyse Prognoserelevanter Faktoren Bei 160 Patienten","volume":"83","author":"Lehnhardt","year":"2012","journal-title":"Chirurg"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3389\/fonc.2019.01300","article-title":"Efficacy and Safety of Microsurgery in Interdisciplinary Treatment of Sarcoma Affecting the Bone","volume":"9","author":"Zeller","year":"2019","journal-title":"Front. Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1016\/j.otsr.2018.12.015","article-title":"Assessment of Resection Margins in Bone Sarcoma Treated by Neoadjuvant Chemotherapy: Literature Review and Guidelines of the Bone Group ( GROUPOS ) of the French Sarcoma Group and Bone Tumor Study Group (GSF-GETO\/RESOS)","volume":"105","author":"Mascard","year":"2019","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/s12957-016-0973-7","article-title":"Forequarter Amputation: A Safe Rescue Procedure in a Curative and Palliative Setting in High-Grade Malignoma of the Shoulder Girdle","volume":"14","author":"Elsner","year":"2016","journal-title":"World J. Surg. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1007\/s00104-011-2136-2","article-title":"Forequarter amputation of the right upper chest: Limitations of ultra radical interdisciplinary oncological surgery","volume":"82","author":"Dragu","year":"2011","journal-title":"Chirurg"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1053\/j.jvca.2008.09.009","article-title":"The Management of Chest Wall Resection in a Patient with Polyostotic Fibrous Dysplasia and Respiratory Failure","volume":"23","author":"Collins","year":"2009","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1097\/01.ta.0000221264.45435.79","article-title":"Combination of a Total Free Forearm Flap and a Sensate Local Flap for Preservation of the Shoulder Girdle in Massive, Nonreplantable Upper Extremity Injuries","volume":"66","author":"Jakubietz","year":"2009","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1002\/micr.30124","article-title":"Free Fillet Flap Application to Cover Forequarter or Traumatic Amputation of an Upper Extremity: A Case Report","volume":"36","author":"Scaglioni","year":"2016","journal-title":"Microsurgery"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1097\/PRS.0b013e3181cb6548","article-title":"Reconstruction of Massive Oncologic Defects Using Free Fillet Flaps","volume":"125","author":"Yu","year":"2010","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_30","first-page":"368","article-title":"The Epaulette Flap: Replantation of Osteomyocutaneous Forearm Segments in Interscapulo-Thoracic Amputation","volume":"63","author":"Steinau","year":"1992","journal-title":"Chirurg"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1097\/PRS.0b013e3181b98c9c","article-title":"Chest Reconstruction: I. Anterior and Anterolateral Chest Wall and Wounds Affecting Respiratory Function","volume":"124","author":"Netscher","year":"2009","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.ejcts.2009.12.046","article-title":"Malignant Primary Chest-Wall Tumours: Techniques of Reconstruction and Survival","volume":"38","author":"Gonfiotti","year":"2010","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1016\/S0003-4975(99)01422-8","article-title":"Functional Assessment of Chest Wall Integrity after Methylmethacrylate Reconstruction","volume":"69","author":"Lardinois","year":"2000","journal-title":"Ann. Thorac. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1097\/00006534-199610000-00008","article-title":"Chest-Wall Reconstruction: An Account of 500 Consecutive Patients","volume":"98","author":"Arnold","year":"1996","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1016\/j.thorsurg.2015.07.013","article-title":"Chest Wall Resection and Reconstruction: Management of Complications","volume":"25","author":"Hazel","year":"2015","journal-title":"Thorac. Surg. Clin."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"119","DOI":"10.5761\/atcs.oa.14-00195","article-title":"Results of Bony Chest Wall Reconstruction with Expanded Polytetrafluoroethylene Soft Tissue Patch","volume":"21","author":"Huang","year":"2015","journal-title":"Ann. Thorac. Cardiovasc. Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/j.thorsurg.2017.01.012","article-title":"Primary Tumors of the Osseous Chest Wall and Their Management","volume":"27","author":"Thomas","year":"2017","journal-title":"Thorac. Surg. Clin."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1007\/s00104-010-2013-4","article-title":"Management of mesh-related infections","volume":"82","author":"Dietz","year":"2011","journal-title":"Chirurg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1007\/BF02303578","article-title":"Forequarter Amputation with Fasciocutaneous Deltoid Flap Reconstruction for Malignant Tumors of the Upper Extremity","volume":"4","author":"Volpe","year":"1997","journal-title":"Ann. Surg. Oncol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1097\/01.blo.0000127583.25477.2b","article-title":"Technique of Forequarter (Interscapulothoracic) Amputation","volume":"423","author":"Ferrario","year":"2004","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1002\/jso.20482","article-title":"Reconstruction of the Chestwall and Thorax","volume":"94","author":"Skoracki","year":"2006","journal-title":"J. Surg. Oncol."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Lasso, J.M., Uceda, M., Pe\u00f1alver, R., Moreno, N., Casteleiro, R., and Cano, R.P. (2010). Large Posterior Chest Wall Defect Reconstructed with a De-Epithelised Trans-Thoracic TRAM Flap. J. Plast. Reconstr. Aesthet. Surg., 63.","DOI":"10.1016\/j.bjps.2009.07.003"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1289","DOI":"10.1016\/j.bjps.2009.07.006","article-title":"A Novel Approach to Thoracic Wall Reconstruction Based on a Muscle Perforator","volume":"63","author":"Kishi","year":"2010","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e232","DOI":"10.1016\/j.bjps.2014.05.010","article-title":"Re: Shoulder Silhouette and Axilla Reconstruction with Free Composite Elbow Tissue Transfer Following Interscapulothoracic Amputation","volume":"67","author":"Hubmer","year":"2014","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1162","DOI":"10.1016\/j.bjps.2014.03.026","article-title":"Re: Shoulder Silhouette and Axilla Reconstruction with Free Composite Elbow Tissue Transfer Following Interscapulothoracic Amputation","volume":"67","author":"Wilks","year":"2014","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1007\/s12035-017-0718-9","article-title":"Coping with Phantom Limb Pain","volume":"55","author":"Kuffler","year":"2018","journal-title":"Mol. Neurobiol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1097\/AIA.0000000000000095","article-title":"Phantom Limb Pain A Review of the Literature","volume":"54","author":"Luo","year":"2016","journal-title":"Int. Anesthesiol. Clin."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1097\/SLA.0000000000003088","article-title":"Targeted Muscle Reinnervation Treats Neuroma and Phantom Pain in Major Limb Amputees: A Randomized Clinical Trial","volume":"270","author":"Dumanian","year":"2019","journal-title":"Ann. Surg."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"2161","DOI":"10.1097\/CORR.0000000000001323","article-title":"Targeted Muscle Reinnervation Improves Residual Limb Pain, Phantom Limb Pain, and Limb Function: A Prospective Study of 33 Major Limb Amputees","volume":"478","author":"Mioton","year":"2020","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/j.jamcollsurg.2018.12.015","article-title":"Preemptive Treatment of Phantom and Residual Limb Pain with Targeted Muscle Reinnervation at the Time of Major Limb Amputation","volume":"228","author":"Valerio","year":"2019","journal-title":"J. Am. Coll. Surg."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"2984","DOI":"10.1007\/s11999-014-3528-7","article-title":"Targeted Muscle Reinnervation: A Novel Approach to Postamputation Neuroma Pain","volume":"472","author":"Souza","year":"2014","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1302\/0301-620X.77B2.7706328","article-title":"Resection-Replantation for Primary Malignant Tumours of the Arm. An Alternative to Fore-Quarter Amputation","volume":"77","author":"Windhager","year":"1995","journal-title":"J. Bone Joint Surg. Br."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"792","DOI":"10.1002\/bjs.6555","article-title":"Forequarter Amputation for Malignancy","volume":"96","author":"Rickelt","year":"2009","journal-title":"Br. J. Surg."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.ejcts.2010.03.071","article-title":"Subjective and Objective Assessment of Quality of Life after Chest Wall Resection","volume":"39","author":"Heuker","year":"2011","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"410","DOI":"10.4037\/ajcc2010354","article-title":"Informational Coping Style and Depressive Symptoms in Family Decision Makers","volume":"19","author":"Hickman","year":"2010","journal-title":"Am. J. Crit. Care"}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/12\/4\/560\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:48:32Z","timestamp":1760136512000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/12\/4\/560"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,1]]},"references-count":55,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2022,4]]}},"alternative-id":["jpm12040560"],"URL":"https:\/\/doi.org\/10.3390\/jpm12040560","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,1]]}}}