The psychosocial burden of visible disfigurement following traumatic injury

Abstract

Hundreds of thousands of individuals experience traumatic injuries each year. Some are mild to moderate in nature and patients experience full functional recovery and little change to their physical appearance. Others result in enduring, if not permanent, changes in physical functioning and appearance. Reconstructive plastic surgical procedures are viable treatments options for many patients who have experienced the spectrum of traumatic injuries. The goal of these procedures is to restore physical functioning and reduce the psychosocial burden of living with an appearance that may be viewed negatively by the patient or by others. Even after receipt of reconstructive procedures, many patients are left with residual disfigurement. In some, disability and disfigurement may be so profound that individuals are candidates for vascularized composite allotransplantation (VCA) procedures, i.e., the transplantation of a vascularized human body part containing multiple tissue types (skin, muscle, bone, nerves, and blood vessels) as an anatomical and/or structural unit. This narrative review paper summarizes the literature on the psychosocial burden experienced by those who have visible disfigurement. While many of these individuals experience stigma and discrimination, relatively few studies have employed a stigma framework to understand the psychosocial sequelea. This paper briefly addresses this framework. Last, particular focus is given to the psychosocial issues of individuals with particularly severe injuries who are potential candidates for VCA procedures.

Vascularized composite allotransplantation: emerging psychosocial issues in hand, face, and uterine transplant

“…It has been shown that, on the one hand, rehabilitation can be positively influenced by a high level of pretransplant activities of daily living, but on the other hand, the rehabilitation process can be experienced as a ‘difficult road’ paved with a variety of complications and challenges. Intense training interventions and a high degree of self-motivation led to steady improvements, in terms of sensibility and motor skills, even after several years [35 ▪ ].…”

“…Additional research is needed to understand the nuances of patient, provider, and caregiver attitudes and perspectives on the VCA decision. The relationship between impairments in physical functioning, the psychosocial status and functioning of potential VCA candidates, and their appropriateness for a VCA procedure still needs to be investigated in future research initiatives [35 ▪ ].…”

“…The psychological burden that could be caused by, for instance, visible disfigurement may increase the vulnerability to psychological distress (depression, anxiety, and body image dissatisfaction). In the case of upper extremity and face VCA, these procedures have another major goal of restoring physical appearance to an approximation of normal – ‘feeling whole again’ [35 ▪ ,44–50].…”

Psychosocial and bioethical challenges and developments for the future of vascularized composite allotransplantation: A scoping review and viewpoint of recent developments and clinical experiences in the field of vascularized composite allotransplantation

“…In terms of appropriate psychological acceptance of the disfigured body (in case of hand and face transplantation), research found that some patients with bodily disfigurement become social recluses, indicating a possible maladaptive coping mechanism ( Sarwer et al, 2022 ). Therefore, many VCA centers raised the question, whether VCA candidates should be required to demonstrate a period of appropriate social interaction before undergoing the VCA procedure.…”

“…Therefore, many VCA centers raised the question, whether VCA candidates should be required to demonstrate a period of appropriate social interaction before undergoing the VCA procedure. This requirement may necessitate an understanding of the patient’s baseline social behaviors prior to bodily disfigurement ( Sarwer and Crerand, 2008 ; Sarwer and Spitzer, 2012 ; Sarwer et al, 2022 ).…”