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Operative management of self-inflicted upper extremity amputations: A retrospective case series
Yehuda A Masturov1, Annie C Schmidt1, Keziah Smallhorne2
1Philadelphia Hand to Shoulder Center, Thomas Jefferson University Hospital, 834 Chestnut St G114, Philadelphia 19107, PA, United States.
Hand Surgery & Rehabilitation
|May 9, 2026
Summary
Self-inflicted upper extremity amputations can be replanted, even with psychiatric conditions. Decisions should prioritize surgical criteria and rehabilitation potential, with early psychiatric support for optimal outcomes.
Area of Science:
- Orthopedic Surgery
- Psychiatry
- Trauma Surgery
Background:
- Self-inflicted upper extremity amputations present unique surgical challenges.
- Psychiatric decompensation is often a contraindication to replantation, but evidence is limited.
- This study examines injury characteristics, psychiatric comorbidities, and outcomes in these rare cases.
Purpose of the Study:
- To describe injury characteristics, psychiatric comorbidities, and operative decision-making for self-inflicted upper extremity amputations.
- To evaluate clinical outcomes of replantation versus revision amputation in this patient population.
- To inform surgical decision-making and psychiatric support strategies.
Main Methods:
- Retrospective review of traumatic upper extremity amputations and replantations (2017-2024).
- Exclusion of accidental, occupational, and non-self-inflicted injuries.
- Descriptive summary of demographics, psychiatric history, injury details, surgical management, and outcomes.
Main Results:
- Seven patients met inclusion criteria; most injuries were suicide attempts (71%) with major depressive disorder (57%).
- Common injury mechanisms included knives and saws; amputation levels varied, with some bilateral cases.
- Three patients (43%) underwent replantation, four (57%) revision amputation; no replantation was denied due to psychiatric instability.
Conclusions:
- Psychiatric comorbidity did not prevent replantation, and no re-injury occurred postoperatively.
- Replantation decisions require objective surgical criteria, considering engagement, rehabilitation potential, and functional recovery.
- Early psychiatric involvement is crucial for stability and optimizing long-term outcomes.
