Case series on defense mechanisms in patients for reconstructive hand transplantation: Consideration on transplant defense concept

Background: The technical demands of reconstructive hand transplantation (RHT) and need for complex multidisciplinary care have led to intense research efforts to improve patient care and outcomes. However, RHT is an extraordinary life event which carries the potential for long-term consequences including psychological distress, which invokes coping and defense mechanisms. Material/Methods: Little is known about the relationship between psychological defense mechanisms and health outcomes in RHT patients. In an effort to elucidate this relationship, we studied seven RHT patients who underwent standardized psychological assessment either pre- or post transplantation. Results: No single defense concept was identified as common to all patients, which we suspect was due in part to the varied mechanisms of hand loss. All seven patients demonstrated diverse psychological reactions to RHT. The self-reported defense styles were associated with psychological adjustment. The patients who reported defenses that distorted reality described less adaptive functioning and psychological well-being. Conclusions: These preliminary findings reveal the varied psychological mechanisms invoked in RHT patients. An assessment of defense mechanisms should be part of multicenter evaluation protocols that address unique psycho-social aspects of RHT in large samples, in order to better guide psychological management.