How Should Surgeons Balance Transplantation Innovation With Acceptance of a Trauma Survivor's Appearance?

Abstract

Clinical and ethical issues involved in counseling a patient about reconstructive surgery for a traumatic and disfiguring injury require special consideration. This article proposes prioritizing 2 considerations: (1) the influence of traumatic experiences on a survivor's cognitive processes and (2) insights into a survivor's acceptance of his or her posttrauma appearance or consent to high-risk or experimental surgery, which can be gained from dialectical behavior therapy. This article argues that these priorities should be explicitly discussed by plastic surgeons counseling patients whose appearances are altered by trauma. CaseAbout 40% of Dan's face was burned in an accident many years ago. Several sites on Dan's body have also been scarred by skin-harvesting from numerous reconstructive surgeries. Although many years have passed since the accident, Dan still suffers long-term grief and feels profoundly depressed about not having a romantic partner. Dan also feels hopelessness and sadness about his surgeons having said they've exhausted traditional reconstructive options on his face. Specifically, Dan remembers his plastic surgeon once stating, "There's nothing else we can do" to improve appearance, ability to speak, or ability to eat easily.Dan's feelings of grief, longing, hopelessness, and sadness are made even more complex by his feeling guilty about not being able to just accept his face as it is. Dan feels solidarity with other burn survivors, whom he meets occasionally at conferences and support groups, and he feels it is important to resist cultural and social pressure both to medicalize his survivorship more than necessary and to try to meet unrealistic standards of "normal" physical appearance. He feels torn between wanting to accept his appearance as it is and wanting it to be good enough for a prospective romantic partner to find attractive.