Self-Inflicted Wrist Injuries in Flexor Tendon Zone V: Clinical Patterns, Management Strategies, and Outcomes

Self-inflicted wrist injuries, particularly those involving flexor tendon zone V, constitute a distinct and clinically challenging subset of upper-extremity trauma with profound surgical, functional, and psychosocial implications. For every suicide, many involve wrist lacerations capable of compromising tendinous, neural, and vascular structures and resulting in long-term disability. Despite their clinical relevance, the literature remains fragmented, with no universally accepted definition of "spaghetti wrist," a term originally described in early surgical series of extensive volar wrist lacerations, and no standardized management framework. This narrative review critically synthesizes current evidence on epidemiology, injury mechanisms, classification systems, clinical assessment, management strategies, rehabilitation, complications, and outcomes. PubMed/MEDLINE, Scopus, and Google Scholar were searched for English- and Spanish-language studies published between January 2005 and January 2025, including cohort studies, case series, case reports, and reviews addressing self-inflicted injuries involving flexor tendon zone V. Extracted variables encompassed epidemiologic patterns, injury characteristics, classification systems, including the Verdan flexor tendon zone framework and heterogeneous "spaghetti wrist" definitions, diagnostic and outcome assessment tools, surgical and non-surgical management, rehabilitation protocols, and functional recovery. Findings were synthesized qualitatively to identify recurring patterns, areas of consensus, and persistent knowledge gaps. Available evidence indicates that these injuries predominantly affect young adults, frequently men, with a high prevalence of psychiatric comorbidity. Injury patterns characteristically involve the dominant hand acting upon the non-dominant wrist and demonstrate extensive multistructural compromise. Flexor tendons are almost universally injured, while neurovascular involvement varies but serves as the principal determinant of long-term functional prognosis. Substantial heterogeneity in reported outcomes reflects inconsistencies in injury definitions, surgical techniques, rehabilitation strategies, and evaluative metrics. Psychiatric factors further influence recurrence risk, adherence to therapy, and return-to-work trajectories. Self-inflicted flexor tendon zone V injuries, therefore, represent a complex and heterogeneous clinical entity. Although advances in microsurgical repair and structured rehabilitation have improved functional recovery, prognosis remains guarded in the presence of neurovascular damage. Standardized definitions, validated outcome measures, and integrated multidisciplinary care, encompassing surgical, rehabilitative, and psychiatric domains, are essential to enhance interstudy comparability and optimize patient-centered outcomes.