Current Management of Self-Inflicted Wounds in Surgery: A Critical Review.

OBJECTIVE: Despite the presence of self-inflicted wounds (SIWs) across all of medicine, our current understanding of SIWs in surgery is limited. Here, we detail the pertinent aspects of the history, diagnosis, decision making, and management of SIWs as they relate to the field of surgery. In addition, we present the first comprehensive review of SIWs across the surgical literature.

SUMMARY BACKGROUND DATA: Self-inflicted wounds have been recognized for much of recorded human history and span a wide spectrum of patient behaviors, motivations, and underlying psychiatric illnesses.

METHODS: We performed a comprehensive literature review of SIWs in the surgical literature. In total, 189 articles were identified.

RESULTS: The most common site of primary SIW was the upper extremity (36.2%), and the most common presenting injuries were lacerations (22.7%). Forty-two percent of patients had received prior surgical procedures for their SIWs, and the average length of time preceding treatment or diagnosis of an injury as an SIW was 2.29 years. Self-inflicted wounds resulting from foreign body insertions were most common (25.9%). Psychiatric factors accounted for most SIW production (35%), of which factitious disorder was the most common (12.7%). Other motivations for SIW production included autoeroticism (8.6%), substance related (6.6%), organic brain disease (5.0%), and self-therapy/surgery by patients (1.7%). Surgical management was ultimately required for nearly 75% of SIWs and was successful in most cases.

CONCLUSIONS: Self-inflicted wounds are frequently encountered in all surgical specialties and encompass many anatomic locations, presentations, and patient-motivating factors. Surgical intervention is common, and successful outcomes are often achieved.