[Anxiety and reconstructive surgery in children and adolescents]

Study of 133 children and adolescents hospitalized and operated in child and adolescent reconstructive surgery. We will study the fantasy representations of anxiety as it is expressed by this population, as well as the psychological repercussions of surgical interventions: behavior disorders, depression, anxiety. We will show that pre-adolescents and adolescents represent the most vulnerable patients in regard to the anxiety triggered by the surgical act and that some of them experience, at the time of the operation, episodes of psychic disorganization of psychotic appearance. We will look into the impact of this mutilating surgery and the weight of severe orthopedic handicaps, and have noted that the expression of anxiety isn't always in relation to the seriousness of the handicap and/or that of the intervention. The anxiety is linked to the psychological balance of the child which is largely due to the relationship he has with his parents and the feeling of self-esteem that the child has if he is accepted as he is. The surgeon seems to us like an important element in the dynamic of the way anxiety is dealt with since the patient and his parents establish a truly transferential bond to him that is of great intensity. The number of school problems, relational and behavioral difficulties and depressive reactions noted in this population shows that reconstructive surgery is very disorganizing for the personality and acts as a psychological trauma.