Compartment Syndrome and Medical Malpractice, the Facts

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The forearm muscles are contained within three fibrous sheaths, unyielding as if they are leather. When there is a fracture of one or both of the forearm bones, the radius and/or ulna, there will be bleeding within that location. However, that bleeding is contained within the fibrous sheath, and will put pressure against the adjacent blood vessels, the muscles and nerves. If the bleeding is extensive, this creates an internal tourniquet-like effect, and unless relieved timely, this will result in irreversible gangrene of the muscles and nerves. These muscles and nerves control function of the hand.

If there is loss of motion and/or numbness in the hand, the first concern is that of a tight cast wherein the swelling from the fracture against the inside of the cast first appears to be caused by too tight a cast. The standard of care requires that both the cast and the padding beneath be severed longitudinally, and then the patient observed. If the problem was just from the cast, the hand will regain sensation and motion. Also by pinching the fingers, the capillary blood flow will be seen to have immediately resumed.

However, if that does not rapidly resolve the problem, then compartment syndrome is the correct diagnosis to be immediately treated. The the skin and the underlying fibrous sheath involved with that compartment is severed longitudinally to relieve the compression, this internal tourniquet-like effect. The failure to properly make this diagnosis and treat with urgent surgery is a departure from the accepted standards of care.

Surgical Mesh Complications in Hernia Repairs

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A hernia is a weakness in the abdominal musculature, through which the intestines can protrude. For many years, since the late 1800s, surgeons have been repairing this weakness by suturing the layers of the adjacent fibrous flesh together.

However, because of the low but significant failure rate of the original suturing to hold, requiring a repeat hernia operation, which by itself is not a departure from the accepted standards of care, or when an operation was required to repair a very large hernia, surgeons have been using a plastic woven cloth, a mesh. This allows the body’s scar tissue to grow into this material, to serve as an internal girdle, a buttress, to decrease the failure of the surgical repair.

Whenever any foreign material is inserted into the human body, there is an increased risk of infection. The presence of foreign material makes it much more difficult for the body to fight off any infection. Even with the most sterile procedures, there is that very small risk of infection, including from the human body itself, such as from brushing teeth, where germs can enter the bloodstream and “seed out” at that surgical mesh site.

Furthermore, whenever any foreign material enters the human body, there is a small propensity for the body to eliminate it, as if it were a splinter working its way through the skin.

The standard of care requires that the surgeon explain the need for the use of the mesh to lower the failure rate for the hernia repair. And during this discussion, the surgeon also needs to inform the patient of the slight increased risk for infection, as well as the possibility for the foreign substance to work its way out of the body.