This paper examines the psychological and social impact of reconstructive surgery for hemi-facial palsy and considers psychosocial factors which may be associated with patient satisfaction. It reports a retrospective study in which 106 adults were assessed using primarily qualitative methods. All participants had undergone two-stage reconstruction using vascularised free muscle grafts, with all procedures having been carried out by the same surgeon. The participants were all at least 12 months post-surgery. They were assessed using demographic questionnaires, the hospital anxiety and depression scale (HADS) and the facial paralysis evaluation measure (FPEM). In addition, all participants were interviewed using a semi-structured format, the interviews were recorded verbatim and the transcripts were analysed using thematic analysis. Of the total study group, 67% had acquired facial palsy. The mean age of the total group was 44.7 years and 67.9% were female. As a group they were rather less depressed than the normal population with similar levels of anxiety to population norms. The primary motivation for surgery was appearance rather than function. Using interview data in addition to the FPEM, satisfaction with the process and outcome of surgery was assessed. Thirty five percent were very satisfied with both process and outcome, 34% were satisfied with the outcome but found the treatment process stressful, 15.1% were not entirely satisfied with process or outcome but felt surgery had been worthwhile as there had been some improvement. The remainder were very dissatisfied with both process and outcome and regretted having undergone surgery. There was no significant association between dissatisfaction and anxiety, the cause of the acquired palsy, longevity prior to surgery, gender nor whether the condition was acquired or congenital. There was a significant relationship with depression, in that those who were suffering from depression were more likely to be dissatisfied with surgery. Participants were asked in interview about social pressures and comments or remarks made by others about their condition. The majority (89.6%) of the total study group reported intrusive questions by acquaintances and strangers, with more than half of these being distressed by such questions. Following surgery, there was a significant reduction in the incidence of these questions. There was no relationship between distress in response to these questions prior to surgery and dissatisfaction with surgery. However, 27.4% also reported aggressive hurtful comments before surgery with a minimal improvement in incidence following surgery. These participants also reported consistent patterns of social avoidance and social isolation before and after surgery, and were more likely to be depressed than the rest of the study group. They were significantly more likely to be dissatisfied with surgery (p=.016). It is recommended that patients are screened and counseled prior to surgery to identify such problems and referred for psychological treatment in order to ensure they gain maximum benefit from reconstructive surgery.

译文

本文研究了重建手术对半面瘫的心理和社会影响,并考虑了可能与患者满意度相关的社会心理因素。它报告了一项回顾性研究,其中主要使用定性方法评估了106名成年人。所有参与者都使用血管化的游离肌肉移植物进行了两阶段的重建,所有手术均由同一位外科医生进行。参与者均在术后至少12个月。使用人口学问卷,医院焦虑和抑郁量表 (HADS) 和面瘫评估量表 (FPEM) 对他们进行评估。此外,使用半结构化格式对所有参与者进行了访谈,逐字记录访谈,并使用主题分析对成绩单进行分析。在整个研究组中,有67% 人患有面部麻痹。该组的平均年龄为44.7岁,67.9% 为女性。作为一个整体,他们比正常人群的抑郁程度要低得多,焦虑程度与人口规范相似。手术的主要动机是外观而不是功能。除FPEM外,还使用访谈数据评估了对手术过程和结果的满意度。30名5% 对过程和结果都非常满意,34% 对结果感到满意,但发现治疗过程压力很大,15.1% 对过程或结果并不完全满意,但认为手术值得,因为有所改善。其余的人对过程和结果都非常不满意,并对接受手术感到遗憾。不满意和焦虑,后天性麻痹的原因,手术前的寿命,性别以及疾病是后天性还是先天性之间没有显着关联。与抑郁症有显着的关系,因为那些患有抑郁症的人更有可能对手术不满意。在采访中,参与者被问及社会压力以及他人对其状况的评论或评论。整个研究小组中的大多数 (89.6%) 报告了熟人和陌生人提出的侵入性问题,其中一半以上的人对此问题感到困扰。手术后,这些问题的发生率显着降低。手术前对这些问题的困扰与对手术的不满之间没有关系。然而,27.4% 还报告了手术前的侵袭性伤害性评论,手术后发病率的改善很小。这些参与者还报告了手术前后一致的社交回避和社交隔离模式,并且比研究组的其他成员更容易抑郁。他们更可能对手术不满意 (p =.016)。建议在手术前对患者进行筛查和咨询,以发现此类问题并转介进行心理治疗,以确保他们从重建手术中获得最大收益。

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