Self–wrist cutting injuries include all volar wrist lacerations from superficial to extensive deep injury caused by self-cutting associated with or without suicidal intent. This injury has special clinical significance because it has the potential to lead to devastating disability and repeated suicide attempts.1 To achieve optimum treatment outcomes, this injury should be evaluated and managed by considering simultaneous traumatologic and psychological aspects. In the present report, we review aspects of self–wrist cutting injury and describe treatment principles for balanced care.
A retrospective review of 72 patients who underwent treatment for self–wrist cutting injury at the Korea University Medical Center between July of 2001 and June of 2010 was performed. Traumatologic data including wound features and injured structures and psychological data related to behavior characteristics and mental status were collected. The patients were divided into three groups based on the severity of the injury (Fig. 1). Functional restoration of the hands was assessed using a hand functional grading system based on intrinsic muscle and sensory tests2 and tendon functional grading system.3 Each grade was translated into a numerical score, and the two grading system scores were added together to obtain a total score. Lastly, comparative analysis of various psychological parameters was conducted.
Unlike previous studies,1,2,4 the laceration wounds were predominantly located on the radial side of the wrist, and central tendons such as the palmaris longus and the flexor carpi radialis were frequently injured. This may be because most patients supinate their wrists to cut their volar wrists. The number of patients in each severity group was as follows: 16 patients (22.2 percent) in the mild group, 37 patients (51.4 percent) in the moderate group, and 19 patients (26.4 percent) in the severe group. Functional outcomes are summarized in Table 1. Most patients (72.2 percent) obtained excellent or good functional recovery. Only five patients (6.9 percent) obtained poor results, but all of them suffered from severe functional loss. In particular, three of four patients who committed additional fatal suicide attempts obtained poor outcomes because the wrist treatment was delayed as a result of emergency care of associated injuries (Fig. 2). These findings show that rapid initial assessment and well-organized collaborative care with other specialists are crucial for preventing tremendous disability. Fourteen patients (19.44 percent) cut their wrists with suicidal intent, and three of them reattempted wrist cutting during follow-up. However, most patients cut impulsively without suicidal intent. Our results agree with previous findings that wrist cutting usually represents a low intention of suicide but instead reflects poor emotional regulation.5 Presence of suicidal intent was irrelevant to injury severity and functional recovery. This finding implies that all patients who cut their wrists need to be evaluated by a psychiatrist to uncover suicidal intent even though the injuries seem trivial.
The overall prognosis of self–wrist cutting injuries was favorable. However, to minimize catastrophic disability and repeated suicide attempts, a balanced approach considering traumatologic and psychological aspects of these injuries is essential.
Ja Hea Gu, M.D., Ph.D.
Seong-Ho Jeong, M.D., Ph.D.
Department of Plastic Surgery, Korea University Guro Hospital, Seoul, Korea
No authors involved in the production of this communication have any commercial associations that might pose or create a conflict of interest with the information presented herein. No intramural or extramural funding supported any aspect of this article.
1. 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;115:1609–1617.
2. Kabak S, Halici M, Baktir A, Türk CY, Avşarogullari L. Results of treatment of the extensive volar wrist lacerations: ‘The spaghetti wrist.’ Eur J Emerg Med. 2002;9:71–76.
3. Lister GD, Kleinert HE, Kutz JE, Atasoy E. Primary flexor tendon repair followed by immediate controlled mobilization. J Hand Surg Am. 1977;2:441–451.
4. Bukhari AJ, Saleem M, Bhutta AR, Khan AZ, Abid KJ. Spaghetti wrist: Management and outcome. J Coll Physicians Surg Pak. 2004;14:608–611.
5. Runeson B, Tidemalm D, Dahlin M, Lichtenstein P, Långström N. Method of attempted suicide as predictor of subsequent successful suicide: National long term cohort study. BMJ. 2010;341:c3222.
Viewpoints, pertaining to issues of general interest, are welcome, even if they are not related to items previously published. Viewpoints may present unique techniques, brief technology updates, technical notes, and so on. Viewpoints will be published on a space-available basis because they are typically less timesensitive than Letters and other types of articles. Please note the following criteria:
- Text—maximum of 500 words (not including references)
- References—maximum of five
- Authors—no more than five
- Figures/Tables—no more than two figures and/or one table
Authors will be listed in the order in which they appear in the submission. Viewpoints should be submitted electronically via PRS' enkwell, at www.editorialmanager.com/prs/. We strongly encourage authors to submit figures in color.
We reserve the right to edit Viewpoints to meet requirements of space and format. Any financial interests relevant to the content must be disclosed. Submission of a Viewpoint constitutes permission for the American Society of Plastic Surgeons and its licensees and assignees to publish it in the Journal and in any other form or medium.
The views, opinions, and conclusions expressed in the Viewpoints represent the personal opinions of the individual writers and not those of the publisher, the Editorial Board, or the sponsors of the Journal. Any stated views, opinions, and conclusions do not reflect the policy of any of the sponsoring organizations or of the institutions with which the writer is affiliated, and the publisher, the Editorial Board, and the sponsoring organizations assume no responsibility for the content of such correspondence.