Medical Malpractice Insights: Ligate only the artery, not a perfectly good nerve

Author: Chuck Pilcher, MD FACEP (Editor, Med Mal Insights) // Editors: Alex Koyfman, MD (@EMHighAK) and Brit Long, MD (@long_brit)

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Chuck Pilcher, MD, FACEP

Editor, Med Mal Insights

Ligate only the artery, not a perfectly good nerve.

Document function before & after laceration repair

Facts: An angry man puts his hand through a plate glass window, severing an artery in his arm. Pressure is futile, so the resident physician begins placing sutures. The bleeding stops, the wound is closed, and the patient discharged to follow up in the hand clinic in a few weeks. When he does so a month later, he sees a second resident and reports persistent numbness and weakness in the 4th and 5th digits. No action is taken, but a follow-up is scheduled in 2 weeks. When he returns, the attending hand surgeon recognizes the loss of nerve function. A delayed repair finds a suture tied around the now dead ulnar nerve just above the wrist. The patient is left with a permanent disability. The record shows no evidence of any functional or neurological exam – either before or after – at the time of repair.

Plaintiff: You never checked my nerve function. You tied off a perfectly good nerve. Even my hand surgeon agrees.

Defense: We did nothing wrong. It was an emergency. You should be glad you’re alive.

Result: Settled immediately prior to jury selection for an undisclosed amount.

Takeaways: Before and after repairing a laceration, document nerve function, especially when working blind. Even a ligated nerve could likely be salvaged if fixed within a few days

Source: Submitted by a plaintiff attorney in NY.

Many times what we perceive as an error or failure is actually a gift. And eventually we find that lessons learned from that discouraging experience prove to be of great worth.     

Richelle E. Goodrich