Orthopedic Surgery Expert Witness Comments on Leg Amputation

This care involves a female patient who suffered a severe injury to her right foot. As a result, she subsequently underwent revision amputation of the affected limb; specifically, a left tib-fib Syme amputation. She was discharged on home care that was to manage his wound. The wound was healing well, but the home healthcare organization failed to adequately treat the wound resulting in amputation of her leg. It was the opinion of the treating physician that the leg could have been saved had the wound been adequately managed.

Question(s) For Expert Witness

1. What could have been done in this situation to avoid further amputation?

Expert Witness Response E-001074

If the amputation (skin) was closed, the wound is usually kept clean and dry with a dressing until the surgeon removes the sutures. If the amputation was left open, the patient usually undergoes dressing changes by a wound nurse. The wound nurse is tasked with alerting the surgeon of any changes to the wound that may be concerning (infection, nonhealing, or dehiscence). A few of the aspects that may be concerning are the breakdown of the wound, lack of tissue regeneration for reconstruction, non-weight bearing status, or significant delay in the identification of an infection. The most important aspects of wound management after an amputation is avoidance of trauma to the stump. There are several causes of further amputation. Depending on the original indication for the amputation, this can include persistent/progressive infection, lack of perfusion for proper wound healing, and certainly further injury from trauma.