A pilot study of 17 wrist-cutting suicide injuries in single institution: perspectives from a hand surgeon

Background

Self-cutting is a special type of emergency in hand surgery. Despite its low mortality rate, it is clinically significant because there is a possibility of permanent disability and repeated suicide attempts are likely to occur. Therefore, we aim to understand the characteristics of self-inflicted wrist injuries and share the perspectives from a hand surgeon in order to inform those who face these patients primarily in the emergency room.

Methods

We reviewed 17 patients with self-inflicted wrist injuries who were referred to the Department of Hand surgery from the Emergency Medicine Department from 2013 to 2017. We investigated the differences in demographic features (age, gender, psychological diagnosis, alcohol consumption, prior suicide attempts) and clinical features (injury side, injury pattern, anatomical structures, distance from wrist crease).

Results

Among the patients, 4 were female and 13 were male. 70.6% of patients (12/17) had injuries on the left wrist and 94.1% of patients (16/17) had injuries on the flexor side. The average distance from the wrist crease to the injured site was 3.43 cm and 90.5% (19/21) of total injuries had an average distance of was less than 5 cm. The most frequently injured structures were palmaris longus tendon (58.5%, 10/17). 52.9% (9/17) of patients, among which 6 of the 8 patients with deep injuries and 3 of the 9 patients with superficial injuries, had a history of a psychiatric disorder.

Conclusions

We conclude that a male with a previously diagnosed psychiatric disorder has a higher chance of inflicting a deeper injury. In addition, self-cutting injuries are highly predictable because most of these injuries occur on the flexor side of the left wrist and are limited to a distance of 5 cm from the wrist crease. 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.

Analysis of 41 suicide attempts by wrist cutting: a retrospective analysis

PURPOSE

Self-cutting injuries have a low mortality rate, but this type of injuries has special clinical significance because they have the potential of leading to devastating disability and repeated suicide attempts. The purpose of this study is to analyze the nature and outcomes of wrist-cutting injuries.

MATERIAL AND METHOD

A retrospective study was designed in order to investigate 41 suicide attempts by wrist cutting attended to Uludag University Faculty of Medicine Emergency Department between June 2008 and December 2014. The patients were analyzed for age, gender, alcohol intake, psychological state, prior suicide attempts, and clinical features such as injury side, injury pattern, and used tool.

RESULTS

It was seen that the severity of wrist-cutting injury variates between gender and age.

CONCLUSION

Alcohol or drug consumption and having a diagnosed psychiatric disorder create a higher risk for extensive wrist lacerations. It was seen that skin only lacerations were most likely to repeat the act and therefore are most in need of psychiatric intervention.

LEVEL OF EVIDENCE

Level III, retrospective study.

Cut wrists, electrocution and subsequent drowning in a water drum: an unusual combination of methods in complex suicide

A 25-year-old male was found dead in a water drum inside the bathroom of his house one morning. Autopsy revealed a fatal right wrist cut, superficial cuts on middle phalanx of left index finger and features of ante mortem drowning. Investigation revealed the victim was an alcoholic and was depressed due to financial problems. On the previous night, under the influence of alcohol, he first tried to commit suicide by cutting wrist with razor blades, but death was not immediate. He then attempted electrocuting himself by touching a live wire, inside the bathroom, which failed and finally he drowned in a water drum. The victim had left a message, written with his blood on the floor of the room, reflecting his suicidal intentions. In complex suicide, many bizarre methods are used, but this combination of methods is unusual and not found in available forensic literature.