Our client was a 55 year old female who underwent an elective total knee replacement. The surgery was performed and our client was placed in the recovery room. Immediately after surgery, the hospital staff in the recover room noted that our client’s foot was cold, red, painful, paralyzed, and pulseless, with slow capillary refill. She was then returned to her regular patient room where she was seen by the doctor who noted that she had foot drop, which was not present before her surgery. These early signs of limb threatening ischemia were misdiagnosed and thought to be temporary.
For seven days our client remained in pain. Her complaints of severe pain were ignored and her foot was not properly evaluated to assess the blood flow to her leg and foot. Neither the nurses nor the physician’s assistant ever removed her sock to closely evaluate her foot. After a week of pain, the sock on our client’s right foot was finally removed for the foot to be properly examined. Her foot was found to be cold, mottled, and without a pulse. In fact, her foot looked so bad that the nurse would not let our client look at her own foot. It was arranged for her to be emergently transferred to a hospital in the same city.
Upon her arrival to the hospital, it was the impression of the physicians that our client was suffering from limb threatening ischemia of her right leg secondary to an arterial occlusion and right popliteal vein occlusion. Due to the delay in diagnosis, the muscles in her leg died as a result of the prolonged, untreated ischemia. She had to endure a painful fasciotomy. She was in renal failure and near death due to the toxins that had progressively built up in her system from her muscles dying from lack of blood flow. Our client underwent several procedures to attempt to regain circulation to her foot, but it appeared that amputation would be imminent. Her treating physician arranged for her to see a specialist who believed that our client’s foot may be salvageable. He performed an operation that entailed harvesting a muscle from her stomach and transplanting it in her leg. This was an extremely painful and invasive procedure, which, unfortunately, was not successful. Due to the lack of blood flow for 7 days after her total right knee replacement, it was determined that her foot was not salvageable. Our client underwent the devastating procedure of having her right leg amputated below the knee.
Our client and her family trusted the healthcare professionals to evaluate her complaints of severe pain and assess her operative extremity. She complained of severe pain after surgery to both the hospital staff and her doctor. Our client’s continual complaints of pain and symptoms of foot drop, redness, and lack of pulse were ignored. If a proper neurovascular assessment had been performed at the onset of her symptoms, then it is likely that her limb threatening ischemia would have been identified much earlier. The early identification of ischemia is imperative in order to restore blood flow to the limb as quickly as possible. The doctor and hospital staff should have performed a neurovascular examination at the first reports of pain. Due to the lack of investigation of our client’s leg for seven days, her leg slowly died from lack of blood flow. Todd Townsley was able to reach a satisfactory settlement to resolve this client’s case.