Suicide in a large West German city — Retrospective study on suicidal cases by sharp force injuries. J Forensic Legal Med. Article Google Scholar. Spaghetti wrist trauma: functional recovery, return to work, and psychological effects. Plast Reconstr Surg.
A prospective study of flexor tendon repair in zone 5. J Hand Surg Br. Graff H, Mallin KR. The syndrome of the wrist cutter. Am J Psychiatry. Google Scholar. Pao PE. The syndrome of delicate self-cutting. Br J Med Psychol. Writs—cutting syndrome: the meaning of a gesture.
Simpson MA. The phenomenology of self-mutilation in ageneral hospital setting. Can Psychiatr Assoc J. Evaluation of superficial and deep self-inflicted wrist and forearm lacerations. J Hand Surg. Youth suicide in Wisconsin: mortality, hospitalizations and risk factors. PubMed Google Scholar. Kapandji A. The average distance from the wrist crease to the injured site was 3. The most frequently injured structures were palmaris longus tendon We conclude that a male with a previously diagnosed psychiatric disorder has a higher chance of inflicting a deeper injury.
In terms of the implements used in self-inflicted injuries, we can predict the type of damage to some degree depending on the type of implement used. In view of these characteristics, more appropriate evaluation can be implemented in the emergency room and those who deal with these patients primarily can cope more effectively for better long-term results.
Peer Review reports. Suicide is a major public health concern and the increase of suicide cases is a serious social problem. It is the 10th leading cause of death worldwide and about one million people died from suicide every year [ 1 ]. In Korea, suicide has been the fourth leading cause of death and the most common cause in adolescents [ 2 ].
The most common causes of the patients who attempted suicide were self-poisoning or self-wrist cutting [ 3 ]. On average, there are 20—25 suicide attempts for every completed suicide, frequently by self-inflicted wrist cutting [ 4 ].
In the United States, the number of patients who attempted suicide and self-inflicted injury increased significantly over the past few decades [ 5 , 6 ]. Demographically, wrist-cutting suicide injuries were more common for under the age of 20 and females [ 5 ]. Self-cutting injuries have a low mortality rate, which means that most of suicide attempts end in survival.
In surviving patients, this is a clinically significant problem because of the risk of permanent disabilities and the repetition of suicide attempts [ 7 ]. Self-inflicted wrist cutting injuries may vary from simple skin lacerations to deep wrist injuries. Consequently, this has a strong effect on the anatomical structures such as arteries, tendons, and nerves, which can lead to motor and sensory dysfunction. Such patients have impaired ability not only to maintain work, hobbies or social activities but also to perform basic activities in daily life.
Thus, wrist cutting injuries should be managed in terms of both psychological intervention and wound treatment [ 8 ]. For psychiatric diagnosis and treatment, all patients who are admitted to the emergency department for attempted suicide should be assessed by a psychiatrist [ 9 ]. In addition, in order to prevent any functional impairment, an initial appropriate evaluation and proper referral are of pivotal importance.
Thus, the objective of this study was to investigate the characteristics of self-inflicted wrist injuries in a single institution and share the perspectives from a hand surgeon so that those who deal with these patients primarily in the emergency room can manage these injuries more appropriately. We investigated all self-inflicted wrist injury patients who were referred to the Department of Hand Surgery from the Emergency Medicine Department in Seoul National University Bundang Hospital from to This study was conducted as a pilot study before a prospective study in the same institution had been initiated from The patients who had skin only injuries were excluded because primary closure was performed at the Emergency Medicine Department.
Demographic data age, gender, alcohol intake, psychological state and clinical features injury side, injury pattern, anatomical structures involved, distance from wrist crease were analyzed.
A psychological evaluation of all the patients was performed following attempted suicide by a psychiatrist from the Department of Psychiatry within the same institution.
Patients were initially assessed in the Emergency Medicine Department and surgical treatment and postoperative wound care were performed by the Hand Surgery Department of Plastic and Reconstructive Surgery Department in the same institution.
The outpatient follow-up period was at least three months and postoperative long-term disability was evaluated. The long-term motor function was assessed by range of motion, opposition of the thumb, intrinsic function tests. Two-point discrimination test was performed in order to evaluate sensory function. A total of 17 patients who attempted suicide by cutting their wrists were included in our study.
Among the patients, four were females and 13 were males. The left wrist was involved in In Only in one case the injury occurred on the radial side of the forearm with involvement of the abductor pollicis longus and the extensor pollicis longus tendons. The most frequently injured structures was the palmaris longus tendon The most frequently injured nerve was the median nerve The ulnar neuro-vascular bundle and the radial artery were involved only once each.
Injuries of important anatomical structures are summarized in Table 1. Knife was the most common tool for suicide attempts, followed by glass Table 2.
Alcohol intake prior to suicide attempts was higher in male patients. All 4 patients with mood disorder had major depression and 2 patients with personality disorder had borderline personality disorder. Among the 8 patients with deep injuries, 6 had a history of psychiatric disorders, whereas among the 9 superficially injured patients, only 3 had a previous psychiatric diagnosis. When it comes to the long-term outcomes, 4 patients showed functional deficit in long-term follow-up period and all of these patients had nerve injuries including injuries of the median and the ulnar nerve.
Patient no. Suicide is a global public health problem that impacts individuals and society. Suicide rates have increased substantially over the past two decades. In addition, we attempted to persuade patients to visit the hospital to receive appropriate treatment. Severity was classified according to the depth-dependent damage of the anatomical structure.
In several previous studies examining wrist injury patterns, the three-layered taxonomy introduced by Lee et al. These studies described the different patterns of damage and anatomical features of self-inflicted wrist injuries and wrist injuries caused by other reasons without suicidal intention e.
We noted that deep layer injuries, the worst in the three-layered taxonomy, were significantly less common in self-cutting patients than in the other two groups. Therefore, in the current study, we classified anatomical injuries dichotomously. We created a virtual line on the anatomy of the wrist, immediately above the median nerve, to examine the relationship between various patient-related factors and the severity of the wrist-cutting injury.
If structures beneath this virtual line were damaged, the injury was classified as deep, while injuries to anatomical structures located above this virtual line were classified as superficial.
The rationale for this classification was that injury of neurovascular structures, including the ulnar artery and radial artery, can lead to critical self-harm. Skin-only injuries with subcutaneous fat exposure were considered to be the most minor. We simplified the anatomy of the wrist structures in a schematic manner and the relative location of each structure was drawn according to the study by Lee et al.
Injuries were dichotomized as deep or superficial based on their location relative to a virtual line running immediately above the median nerve. In accordance with the study by Lee et al. The deep layer comprised structures 8—16, which correspond to the radial artery, flexor pollicis longus, median nerve, second flexor digitorum profundus 2-FDP , 3-FDP, 4-FDP, 5-FDP, ulnar nerve, and ulnar artery, respectively. As we categorized the severity of wrist injuries according to three levels skin only, superficial, and deep , the relationships of various factors with severity was evaluated using the linear-by-linear association test.
The sex ratio was compared to the cumulative population of Seoul during the study period — [ 7 ]. The sex ratios for incidence and repeated wrist cutting were evaluated using the chi-square test. The mean ages of men and women were compared using the independent t-test. This study included patients who had cut their wrists for the purpose of self-harm, of whom 42 patients Women were significantly younger than men mean age, Alcohol consumption and drug abuse prior to wrist cutting were examined in all patients.
Fifty-one patients In cases involving drug intoxication, the most common drugs used were prescription pills e. In one case, a patient consumed a pesticide 50 mL of cypermethrin that was prepared in advance with the intention of committing suicide.
Of the patients, 47 In total, 47 patients For patients who declined psychological counseling, we made several recommendations that they receive psychiatric care through the SPI. The most adherent patient completed 10 SPI sessions.
Twenty-six patients Of the 22 patients who had engaged in wrist cutting repeatedly, 19 The vast majority of patients patients; In addition, patients One patient performed amputation after cutting her wrist for 3 hours.
In total, 82 patients None of the patients died. Thirty-three patients had injured at least one anatomical structure of the wrist. The number of patients who injured each anatomical structure of the wrist are listed in Table 3. The patient who performed amputation was counted once in all cases. The most commonly injured structure was the PL, which was injured in 24 patients The most commonly injured structure in the deep layer was the median nerve, which was injured in 10 patients Previous studies have pointed out the protective role of some tendons against neurovascular injuries [ 5 , 6 ].
Specifically, those studies indicated that the FCR functions as an important protective barrier for the radial artery, and the PL exhibits a similar effect for the median nerve. In our study, all five patients with radial artery injuries had FCR injuries and all 10 patients with median nerve injuries had PL injuries; therefore, our findings validate the proposal that tendons are protective structures.
Of the patients, three refused treatment for the wound, while received skin repair. Tenorrhaphy was performed in 26 patients Purchase access. Rent article Rent this article from DeepDyve. Access to free article PDF downloads. Save your search. Customize your interests. Create a personal account or sign in to:. Privacy Policy. Make a comment.
0コメント