ABSTRACT
Objective: Complex Regional Pain Syndrome type I (CRPS-I) is an often intractable regional pain syndrome, usually affecting limbs in which amputation may be a final resort. Not all patients are suited for amputation.This retrospective case series with explorative interviews aims to gain insight in the quality of life in those who have been denied an amputation and their functioning with CRPS-I. Patients and methods: Between 2011 and 2017, 37 patients were denied an amputation. Participants were interviewed regarding quality of life, treatments received since their outpatient clinic visit and their experiences at our outpatient clinic. Results: A total of 13 patients participated. Most patients reported improvements in pain, mobility and overall situation. All patients received treatments after being denied an amputation, with some reporting good results. Many felt they had no part in decision making. Of the 13 participants 9 still had an amputation wish. Our participants scored worse in numerous aspects of their lives compared with patients with an amputation from a previous CRPS-I study of us. Conclusion: This study shows that amputation should only be considered after all treatments have been tried and failed, since most participants reported improvements in aspects of their functioning over time.
ABSTRACT
BACKGROUND: With the advents of new processing techniques and new graft survival theories in fat grafting, the question is: Which processing technique is of preference? This study systematically reviewed literature regarding current techniques for processing fat grafts. METHODS: PubMed, Embase, Cinahl, and Cochrane databases were searched until August 2015. Studies comparing different fat grafting processing techniques were included. Outcomes were viability of adipocytes, number of adipose-derived stromal/stem cells (ASC) and growth factors in vitro, volume and quality of the graft in animal studies, and satisfaction and volume retention in human studies. RESULTS: Thirty-five studies were included. Adipocyte viability and ASC numbers were the best using the gauze/towel technique (permeability principle) compared to centrifugation. With regard to centrifugation, the pellet contained more ASCs compared to the middle layer. The animal studies' and patients' satisfaction results were not distinctive. The only study assessing volume retention in humans showed that a wash filter device performed significantly better than centrifugation. CONCLUSION: In this study, processing techniques using permeability principles proved superior to centrifugation (reinforced gravity principle) regarding viability and ASC number. Due to the variety in study characteristics and reported outcome variables, however, none of the processing techniques in this study demonstrated clinical evidence of superiority.
