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NY MEDICAL MALPRACTICE- Improperly Placed Suture Causes Permanent Nerve Damage

By Gerry Oginski

Here's an interesting case I handled recently: It involved a young man who put his arm through a window. He was taken to the emergency room where he was bleeding profusely from cutting an artery. He had a "pumper," with blood spurting and pulsating out like a garden hose. While in the emergency room a doctor tried to stop the bleeding by applying pressure to the wound. This worked, but the young man needed a blood transfusion since he lost a lot of blood during the five minutes from accident site to the hospital.

After the bleeding was initially controlled, another doctor came to stitch the wound. The doctor, while throwing stitches, never realized that he put a stitch around the ulnar nerve! This is a big "no-no." Stitches are meant to tie off bleeding vessels like veins and arteries. They are not meant to tie off good, healthy nerves.

Importantly, while the patient was being stitched up, he yelled out that his arm felt as if it had been 'zapped', similar to hitting your funny bone. The doctor simply said "Don't worry about it, you'll be fine." Well, a day or two later, the young man, thinking that it's ok to have unusual sensations in his had following this accident did not think much of the ongoing discomfort he was having in his hand. By day three, he started to think something was really wrong. His fourth and fifth finger were getting numb and were also painful.

The patient returned to the hospital, where it took some coercion to get the clinic residents to evaluate his hand. Despite the patient's complaints, he was sent home, and told it it normal to have this pain following such an accident. Two days later, the numbness and inability to move the fourth and fifth fingers brought the patient back to the hospital clinic. Again, nobody recognized that the young man's ulnar nerve was dying off before their eyes.

This young man made a wise decision to get an opinion from an experienced hand surgeon in New York City. Immediately upon being examined, the hand surgeon advised the patient that he had significant damage to his ulnar nerve; precisely the nerve that controls the fourth and fifth fingers. Exploratory surgery revealed the patient's worst fears:

"A suture used to tie off bleeding vessels had somehow been used instead to tie off your ulnar nerve," was what the hand surgeon advised him. "As a result, your ulnar nerve was deprived of oxygen and blood flow, causing the nerve to die." This young man was told that he'd need another surgery to try and transplant another nerve from a different part of his body into his arm to see if that would help. He was told that nerves can regenerate, if lucky, at a rate of one inch per month. In other words, a very slow process.

The second surgery went well, and he did not need a nerve transplant. Instead, the existing nerve was cleaned up, and stretched as gingerly as possible to get close enough to attempt to reattach the two damaged ends of the nerve. Eighteen months later, this patient still had loss of sensation and decrease in function in his hand.

The moral of this tragic story is that this injury was totally preventable. Had the emergency room doctor been careful in placing those stitches, and had the clinic residents recognized the signs of nerve damage two days after the accident, this event leading to permanent nerve damage never would have happened.

End Result:

Through extensive investigation and many depositions, I was able to finally learn that one or more doctors had sutured the wound closed. What made this case so fascinating is that the doctor or doctors who stitched this patient up, never wrote a note in the hospital chart- It's almost as if they knew what they did was inappropriate and did not want to acknowledge it.

The case settled favorably during jury selection.

Full post as published by New York Medical Malpractice Blog on July 22, 2008 (boomark / email).