Clare Thompson, a Partner in our Clinical Negligence team at Hay & Kilner, acted on behalf of an 18-year old Claimant who was awarded £650,000 following substandard surgery which resulted in him requiring a below the knee amputation.
On 6th October 2015, the Claimant underwent an operation to correct problems for club foot, a condition with which he was born. The procedure comprised the application of a TSF frame to the left foot, TA lengthening, plantar fascia release and giglisaw mid-foot osteotomy. Post-operatively, the Claimant developed acute ischaemia which was not managed by the clinicians until 8th October 2015 when the TSF frame was removed. The Claimant’s left foot remained mottled and cold. Following discharge from Hospital, the condition of the Claimant’s foot continued to be monitored and was managed conservatively. Unfortunately, the condition of the Claimant’s foot continued to deteriorate with oedema, cellulitis and infection requiring treatment with several debridement procedures and also amputation of the toes which had developed gangrene. Despite these attempts, the Claimant’s foot did not improve and, on 23rd December 2016, he underwent a left transtibial amputation. He subsequently had input from the prosthetic rehabilitation team and has managed well.
Supportive expert evidence on breach of duty and causation was obtained from a Consultant Orthopaedic Surgeon and a Consultant Vascular Surgeon respectively. A Letter of Claim was submitted to the Trust alleging that there were failings prior to the operation on 6th October, during the operation and also post-operatively. It was alleged that prior to the operation, there was a failure to perform a formal detailed examination of the Claimant’s foot resulting in a failure to identify the poor pre-existing vascular supply to the Claimant’s foot. Had this anatomical abnormality been identified prior to the operation, it was argued on the Claimant’s behalf that there would have been a surgical plan in place to minimise the risk of injury occurring and the surgical damage would have been avoided. It was also alleged that the operation on 6th October was performed in a substandard manner in that an occlusion of the posterior tibial artery occurred through placement of the gigli saw or placement of one of the pins.
Furthermore, given the poor vascular supply, it was a breach of duty to use a giglisaw during this procedure and, in the absence of an angiogram showing the vessels, an open osteotomy should have been performed. There was also a failure to recognise the surgical damage intra-operatively. Post-operatively there was a delay in recognising and treating the acute ischaemia; it was alleged that had this been diagnosed earlier the Claimant’s foot would have been salvageable and he would have avoided the below the knee amputation.
Breach of duty was also alleged regarding consent in that there was a failure to advise the Claimant of the significant risks of amputation, nerve damage and neurovascular damage prior to the operation. Had the claimant been fully informed of such risks, it was argued that he would not have proceeded with the operation at that time and would have waited until his symptoms became more intrusive. In the Letter of Response the Defendant largely denied breach of duty and causation.
Proceedings were issued and very shortly thereafter, and prior to service, the Defendant proposed Mediation. At Mediation, the Claim settled for £650,000 to reflect the Claimant’s pain, suffering and loss of amenity, loss of earnings, cost of care, travel, equipment, accommodation, treatment and prosthetics.
For more information on any of the above, or how we can help you or your family, please contact a member of our Clinical Negligence team, or call 0191 232 8345.