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Theses

Les amputations traumatiques du membre supérieur : le parcours des patients pour la reconstruction de leur identité corporelle

Abstract : Introduction: This thesis comprises four separate studies that assessed the psychological status of patients who underwent traumatic amputations of the upper limb due to a lack of surgical options that could have prevented part of the limb from being amputated. The main objectives of these four studies were to: Firt study, identify the cases that involved traumatic amputation of the upper limb. Second study, determine the occurrence of pathological traumatic grief following upper limb traumatic amputation. Third study, assess the proportion of patients who had undergone an upper limb traumatic amputation who claimed to have overcome the direct functional consequences of the accident and who did not exhibit signs of pathological grief. Fourth study, assess whether patients more often seek a secondary amputation of a long finger injured in a work accident compared to other types of accidents. Materials & Methods: This thesis was carried out over the course of 11 years at an ‘SOS Mains Adulte’ unit. It involved collection of the medical records of patients treated for a traumatic amputation, using the CCAM (the French Common Classification of Medical Procedures) codes for upper limb rectifications and transplants. Only information regarding full and supported traumatic amputations of the upper limb was compiled. All anatomical levels were considered. Non-traumatic and/or incomplete amputations were excluded, as was the pediatric population (patients under 16 years of age). In the first study, we determined the incidence of traumatic amputations, as well as the proportion of transplant attempts and the failure rate. The epidemiological profiles of the patients were also studied. In the second study, we established the proportion of pathological traumatic mourning in the population of amputated upper limb patients for whom there was not a surgical solution or who could not be successfully transplanted. The risk factors for pathological mourning were also studied. In the third study, we assessed whether there was a correlation between the absence of traumatic pathological mourning and the personal feeling of having returned to the original state in patients who had undergone traumatic upper limb amputations. In the fourth study, we assessed whether patients were more likely to seek a secondary metacarpal base amputation based on whether the accident had taken place in the workplace. Results: The first study: Over the period in question, we identified 1,715 traumatic amputations and an annual incidence of 3% in the population admitted to the emergency department. A transplant was involved in 1%, with 583 identified cases. The second study: A state of traumatic pathological mourning was identified in 39% of the 524 included patients. Both thumb amputation and transplant failure were risk factors for pathological mourning. The third study: None of the patients who claimed to have overcome the direct functional consequences of the accident also suffered from traumatic pathological mourning. Conversely, all of the patients with pathological mourning syndrome stated that they had not been able to overcome the direct functional consequences of the accident. The fourth study: The patients were more likely to seek a secondary amputation when the accident had taken place in the workplace Discussion: Although the incidence of traumatic amputations in the population of ‘SOS Mains’ patients is low, the extent of the functional, psychological, and social repercussions should not be trivialized. Indeed, this type of trauma leads to pathological traumatic mourning in more than a third of cases. This complication following amputation needs to be detected in a systematic and timely manner in order to reduce the impact of traumatic amputation of the upper limb on the lives of victims. However, the absence of traumatic pathological mourning is not synonymous with recovery after the occurrence of an amputation. It is important to assess the return to the original state, which appears to largely depend on the patient's acceptance of the new situation. Before undertaking a secondary metacarpal base amputation following a workplace accident, the surgeon needs to assess the patient’s reasons for seeking further surgery. It is possible that their intention is to use this surgery to obtain secondary material benefits. The patient's psychological distress also needs to be assessed.
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Submitted on : Wednesday, June 9, 2021 - 10:03:36 AM
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  • HAL Id : tel-03254716, version 1

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Germain Pomarès. Les amputations traumatiques du membre supérieur : le parcours des patients pour la reconstruction de leur identité corporelle. Chirurgie. Université de Lorraine, 2020. Français. ⟨NNT : 2020LORR0224⟩. ⟨tel-03254716⟩

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