Vascular Surgery Expert Discusses Mismanaged Ischemia

This case involves a female patient in Indiana who had a below the knee amputation following routine surgery. The patient had undergone a minor orthopedic procedure on her right leg and was discharged the following day. Over the next few days, the patient felt numbness while performing routine activities of daily living. The patient called her doctor to report the issue, and the doctor instructed the patient to go to the ER the next morning if the numbness continued. She presented to the ER the next day with complaints of leg numbness down to her toes. She required a facsciotomy, but was sent home almost immediately with what appeared to be a salvaged limb. The patient returned to the hospital several days later with significant gangrene of the limb, which necessitated an amputation.

Question(s) For Expert Witness

1. Do you routinely treat patients similar to the one described in the case?

2. Do you believe this patient may have had a better outcome if the care rendered had been different?

Expert Witness Response E-001075

Acute limb ischemia can be a surgical emergency that requires prompt intervention. The details of the intervention performed on the initial admission would be of significant importance to determine the severity of the process and burden of disease. The fact that the patient was doing well immediately after discharge does suggest that the initial revascularization attempt was successful. However, the loss of limb just days later clearly demonstrated otherwise. I am busy vascular surgeon working at a large academic referral center. We are the referral center for patients similar to the one described in this case and I have personally accepted patients from over six states. Acute limb ischemia is a complication I commonly treat and manage.