Journal List > J Korean Soc Surg Hand > v.20(1) > 1106486

Cho, Roh, Lee, and Yang: Clinical Characteristic and Psychiatric Features of Self-Inflicted Wrist Laceration: A Single Institute Retrospective Study

Abstract

Purpose:

Self-inflicted wrist laceration is a common injury in the department of hand surgery. The aim of this study was to investigate the clinical characteristics and psychiatric features of self-inflicted wrist laceration using categorization according to wound severity.

Methods:

We reviewed 71 patients from 2002 through 2012. All of the patients were grouped into four groups. Data regarding the following characteristics were collected: age, gender, size, structure involved, instruments used, history of previous self-inflicted injury, comorbidities in psychiatric and presentation of follow-up outpatient appointment to the department of plastic surgery and psychiatry.

Results:

In these patients, approximately 64% of patients were female. About 80% of patients cut their wrist using a knife. And in grade 3-4 injury, percentage of glass injury was relatively high (22%), compared with other grades (3%). Unlike previous studies, patients in grade 3-4 tended to cut their wrist repeatedly. Focusing on psychiatric problems, approximately one quarter of patients had a previous history of self-infliction. In all patient groups, mood disorder was the most common disorder in patients who had a previous psychiatric disorder. But after operation, more than two thirds of patients had not visited department of psychiatry again.

Conclusion:

We identified some other differences among their characteristics. All patients in group also should be evaluated and surgically treated properly. A multidisciplinary approach is required for patients with wrist laceration due to self-injury in comparison to those with laceration due to other causes. Because many of them have previous self-injury experiences and psychiatric disease.

References

1. Fujioka M, Murakami C, Masuda K, Doi H. Evaluation of superficial and deep self-inflicted wrist and forearm lacerations. J Hand Surg Am. 2012; 37:1054–8.
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3. Rashid A, Brennen MD. Psychiatric assessment of patients with self-inflicted lacerations to the wrist and forearm admitted to a nonpsychiatric ward: the experience of a regional plastic surgery unit. J Plast Reconstr Aesthet Surg. 2006; 59:266–71.
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4. Goldwyn RM, Cahill JL, Grunebaum HU. Self-inflicted injury to the wrist. Plast Reconstr Surg. 1967; 39:583–9.
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5. Jaquet JB, van der Jagt I, Kuypers PD, Schreuders TA, Kalmijn AR, Hovius SE. Spaghetti wrist trauma: functional recovery, return to work, and psychological effects. Plast Reconstr Surg. 2005; 115:1609–17.
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Fig. 1.
Previous history of self-inflicted wrist laceration patients (%): approximately one quarter of patients had a previous history of self-infliction.
jkssh-20-1f1.tif
Fig. 2.
Psychiatric and plastic surgery department follow-up arrangements (%): after operation, more than two thirds of patients had not visited department of psychiatry again. f/u, follow-up.
jkssh-20-1f2.tif
Table 1.
Grade of self-wrist laceration by injury depth and related anatomy
Grade Involvement structure
Grade I Skin alone
Grade II Skin, PL, FCR
Grade III Skin,
PL, FCR
FCU, artery and nerve
Grade IV Skin,
PL, FCR
FCU, artery and nerve
FDS and FDP

PL, palmarislongus; FCR, flexor carpi radialis; FCU, flexor carpi ulnaris; FDS, flexordigitorumsuperficialis; FDP, flexordigitorumprofundus.

Table 2.
Distribution of patients by self-wrist laceration grade
Grade Male (patient) Female (patient) Total (patient)
Grade I 3 4 7
Grade II 9 15 24
Grade III 5 16 21
Grade IV 8 11 19
Total (%) 25 (36) 46 (64) 71 (100)
Table 3.
Distribution of patients by involvement structures
Involvement structures No. of patients
Palmarislongus 46
Flexor carpi radialis 28
Flexor carpi ulnaris 16
Radial artery 13
Ulnar artery 6
Median nerve 5
Ulnar nerve 7
Superficial branches of radial nerve 8
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