Worst pop op complication you’ve experienced?

[JustAPedicurist]

What is the worst post op complication you’ve experienced? What did you learn from it? Another side note: have you gotten sued? And if so how many times?

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[air bud]

I had an Achilles repair with speed bridge. Diabetic well controlled. Incision healing appropriately. Except small area distally. No exposed tendon. 5 weeks a bubble forms 5 cm proximal....I watched for maybe a week, then did a swab culture of some drainage....infection. revision surgery took everything out, washed out, IV antibiotics, antibiotics beads, came back attempted redo. I don't remember all the details. It was my first year out. I had already done 3 or 4 Achilles repairs by this time. 3 trips to OR, lots of wound care....plastics consult...ended up sending to an Ortho colleague (pod friendly) in another city and she had her Achilles cut out with an FHL repair. Walks with a ankle brace now.

Patient has told me to my face multiple times it's not my fault. Didn't get sued. Didn't get selected for boards. Taught me a lot about being honest with patients, being vulnerable.

Remember doctors get sued because they attempt to downplay, defer or not take accountability. Certainly a fine line. But ultimately patients will allow you to make mistakes. Also this is why it is critical to spend more time talking about all the risks associated with surgery than talking about how great it will be. Try and truly give them the ability to make an informed consent. Then if something bad happens they said well hey man you told me that could happen....much better than hey bro you never said this could happen .

By far worst complication I have had.

Also, not related to this case, do not do elective surgery on smokers. You don't need it that badly and it will ALMOST always end poorly.

 

[Adam Smasher]

Also, not related to this case, do not do elective surgery on smokers. You don't need it that badly and it will ALMOST always end poorl

Ditto for homeless. They won't say they're homeless, they're just "staying with a friend" or "couch surfing" or "not all who wander are lost" so read between the lines and don't be embarassed to same-day cancel a case

 

[Hybrocure]

Also this is why it is critical to spend more time talking about all the risks associated with surgery than talking about how great it will be. Try and truly give them the ability to make an informed consent. Then if something bad happens they said well hey man you told me that could happen....much better than hey bro you never said this could happen .

This is very important and good advice. I never sell my patients on surgery unless it’s something that needs an amputation. For elective surgery I basically will explain to them what it entails and if they tell me they want it (without any pushing from me) I will then explain the risks and if they still want to do it then we do it.

Thankfully haven’t had any bad complications yet beyond fracture during osteotomy, or pulling k wires due to lack of perfusion. Knock on wood though. The ones where the above happened the patients were very understanding and went on to do well.

No lawsuits or board complaints yet (knock on wood) but from talking to older docs this can happen anytime and sometimes over stupid stuff that you’d think could never happen. Not always a cut and dry screw up but could be as simple as poor communication for what to expect after an office visit.

 

[Feli]

I would guarantee that almost nobody has seen their worst complications... or at least the end of the story on them.

Vascular surgery, gen surg, another DPM, ortho, etc sees them.
Heck, I fix bunions monthly that the DPM probably followed for 6-12mo and thinks turned out roses (failed implant, varus, recur, DJD, symptomatic non-union, etc).

Even when pts are 'trapped' in an insurance system such as Kaiser, IHS, VA, etc, they will still usually find a way to go to another facility or doc for the salvage attempt. I would not go back to the same surgeon for a revision on a major complication... even if I was pretty sure I'd picked a good surgeon to begin with, the stakes are just too high.

 

[Hybrocure]

Ditto for homeless. They won't say they're homeless, they're just "staying with a friend" or "couch surfing" or "not all who wander are lost" so read between the lines and don't be embarassed to same-day cancel a case

“My roommate” is one I will tend to hear a lot from sketchy patients

 

[Shiyuan]

“My roommate” is one I will tend to hear a lot from sketchy patients

You need a new icon. I suggest one @dtrack22 cameod me on:

 

[Hybrocure]

You need a new icon. I suggest one @dtrack22 cameod me on:

Are those the things from Star Wars

 

[heybrother]

Are those the things from Star Wars

Yes. They are called Jawas.

 

[Shiyuan]

Yes. They are called Jawas.

Blasphemy!!!

 

[air bud]

I would guarantee that almost nobody has seen their worst complications... or at least the end of the story on them.

Vascular surgery, gen surg, another DPM, ortho, etc sees them.
Heck, I fix bunions monthly that the DPM probably followed for 6-12mo and thinks turned out roses (failed implant, varus, recur, DJD, symptomatic non-union, etc).

Even when pts are 'trapped' in an insurance system such as Kaiser, IHS, VA, etc, they will still usually find a way to go to another facility or doc for the salvage attempt. I would not go back to the same surgeon for a revision on a major complication... even if I was pretty sure I'd picked a good surgeon to begin with, the stakes are just too high.

I have said before, one of the things that I learned a ton from where I was at in a super rural location was it was only me. I saw all of my follow-ups there was no podiatrist no vascular I worked with ortho. Nobody was driving 3 hours to go see somebody else without coming to see me first. I learned a ton from this and it absolutely made me better.

 

[wakaflocka88]

Hammertoe PIPJ fusion turning dry gangrene leading to amputation.
Ankle fracture - complete dehiscence of entire lateral incision with hardware exposed 2 weeks post op. Eventually healed and fully closed at 6 months after a few applications of integra plus wound vac and just betadine after. Didn’t need a STSG. Maybe that would have sped it up…..

Both relatively “healthy” older patients - no smoking, controlled DM, no bad socioeconomic issues. Just bad luck. I still can’t explain to this day why the ankle fracture dehisced to that extent. I rarely use tourniquet for fractures, I only use deep layer retractors to minimize skin insult, I use the same sutures for my closures, well padded splint, patient was NWB and compliant. Her medial incision healed without a scar.

I did exactly what AirBud said above, I apologized almost every visit and explained to them the best of why I think it happened, and never pointing the finger at them as I did not believe they did anything that deviated from the post op instructions I give them. Both were very happy with my care despite the complications and even the above losing a toe.

Patient selection is paramount, but we all know pods that will hammer every nail they encounter too.

 

[dtrack22]

complete dehiscence of entire lateral incision with hardware exposed 2 weeks post op. Eventually healed and fully closed at 6 months after a few applications of integra plus wound vac and just betadine after. Didn’t need a STSG. Maybe that would have sped it up…..

Would have sped it up by several months.

I just had this same patient though it was orthos post-op, not mine, I just took over as soon as there was a wound. HWR was not quite two months ago and her STSG is incorporating and a week or two from being fully epithelialized.

 

[Redsting]

I had an Achilles repair with speed bridge. Diabetic well controlled. Incision healing appropriately. Except small area distally. No exposed tendon. 5 weeks a bubble forms 5 cm proximal....I watched for maybe a week, then did a swab culture of some drainage....infection. revision surgery took everything out, washed out, IV antibiotics, antibiotics beads, came back attempted redo. I don't remember all the details. It was my first year out. I had already done 3 or 4 Achilles repairs by this time. 3 trips to OR, lots of wound care....plastics consult...ended up sending to an Ortho colleague (pod friendly) in another city and she had her Achilles cut out with an FHL repair. Walks with a ankle brace now.

Patient has told me to my face multiple times it's not my fault. Didn't get sued. Didn't get selected for boards. Taught me a lot about being honest with patients, being vulnerable.

Remember doctors get sued because they attempt to downplay, defer or not take accountability. Certainly a fine line. But ultimately patients will allow you to make mistakes. Also this is why it is critical to spend more time talking about all the risks associated with surgery than talking about how great it will be. Try and truly give them the ability to make an informed consent. Then if something bad happens they said well hey man you told me that could happen....much better than hey bro you never said this could happen .

By far worst complication I have had.

I feel you.

I had someone who I did a Haglund's with a speed bridge. She fell, the repair is good and I've had people fall before so I wasn't too worried. When she came in she had ruptured her Achilles. I go back in and it was ruptured above the midline Achilles incision I made, I could still see the Vyril I put in. So I fix it. The wound dehisces like and it keeps getting bigger and bigger. Wound care didn't cut it. I took her to the OR a couple times. Cultures would come back negative. Sent her for another opinion. She wasn't thrilled with it and I didn't agree with it. I sent her to plastics who then sent her to another plastics who did a free flap on her. We had lots of conversations and know it wasn't my fault. We both know it wasn't her fault. It just sucked. I just saw her today and she is doing great, about a year out. Obviously, I try and learn as to not repeat it in the futures and besides the 2nd surgery I have no idea what lead to this and it not healing.
I would agree that that was my worst complication.

I've seen several people with BKAs who said it was because of a failed ankle fusion or replacement. That would be the worst, in my opinion, if I had something like that happen.

Of course I've had the Lapidus that comes walking in in the splint and has been walking since 1 week s/p. Or doesn't listen and is out of the boot at 3 weeks. Or a hammer to that went septic and had to take the toe. But those are minor compared to that Achilles.

 

[podourology]

I feel you.

I had someone who I did a Haglund's with a speed bridge. She fell, the repair is good and I've had people fall before so I wasn't too worried. When she came in she had ruptured her Achilles. I go back in and it was ruptured above the midline Achilles incision I made, I could still see the Vyril I put in. So I fix it. The wound dehisces like and it keeps getting bigger and bigger. Wound care didn't cut it. I took her to the OR a couple times. Cultures would come back negative. Sent her for another opinion. She wasn't thrilled with it and I didn't agree with it. I sent her to plastics who then sent her to another plastics who did a free flap on her. We had lots of conversations and know it wasn't my fault. We both know it wasn't her fault. It just sucked. I just saw her today and she is doing great, about a year out. Obviously, I try and learn as to not repeat it in the futures and besides the 2nd surgery I have no idea what lead to this and it not healing.
I would agree that that was my worst complication.

I've seen several people with BKAs who said it was because of a failed ankle fusion or replacement. That would be the worst, in my opinion, if I had something like that happen.

Of course I've had the Lapidus that comes walking in in the splint and has been walking since 1 week s/p. Or doesn't listen and is out of the boot at 3 weeks. Or a hammer to that went septic and had to take the toe. But those are minor compared to that Achilles.

Those Achilles wound dehicenses like to spit and spit. One lady we did an achilles and we thought it was infected too, just reactive with fiber wire. Removed fiber wire, light debridement, integra and wound vac. She healed quicker once fiber wire removed.

 

[Redsting]

Those Achilles wound dehicenses like to spit and spit. One lady we did an achilles and we thought it was infected too, just reactive with fiber wire. Removed fiber wire, light debridement, integra and wound vac. She healed quicker once fiber wire removed.

True. At least one of the trips to the OR I pulled out as much fiberwire as I could, I doubt I got it all. Used integra in the OR. I did a wound vac at another point in time.