Does the development of surgical dehiscence, incisional complications, and complex regional pain syndrome 5 months after a Lapidus bunionectomy, Weil osteotomies of the second and third metatarsals, and hammertoe correction indicate negligence?

Surgical Complications After Foot Surgery: Negligence Assessment

The development of surgical dehiscence, incisional complications, and complex regional pain syndrome (CRPS) following a Lapidus bunionectomy and hammertoe correction does not necessarily indicate negligence, as these are known potential complications of foot surgery that can occur despite appropriate surgical technique and care.

Understanding Common Complications in Foot Surgery

Incidence of Complications

• CRPS occurs in approximately 4.36% of elective foot and ankle surgeries 1
• Studies on Lapidus procedures specifically report CRPS rates of 2.7% 2
• Surgical dehiscence and incisional complications are recognized risks in foot surgeries

Risk Factors for Complications

• Middle-aged females have higher risk of developing CRPS after foot surgery 1
• Pre-existing anxiety or depression increases CRPS risk 1
• Multiple surgeries (as in this case with multiple procedures) may increase complication risk

Legal and Medical Standards for Negligence

Standard of Care Assessment

• Complications must be distinguished from negligence in medical-legal evaluation
• As noted in surgical guidelines, some complications are "predictable but not preventable events" rather than "surgical mistakes" 3
• Surgical complications are an unavoidable aspect of procedures, even when performed by qualified surgeons with appropriate technique 3

Informed Consent Considerations

• Proper informed consent should include discussion of potential complications including wound healing issues and CRPS
• The presence of a complication that was disclosed in informed consent generally does not constitute negligence 3

Specific Complications in This Case

Complex Regional Pain Syndrome

• CRPS is a recognized complication of foot and ankle surgery, particularly in procedures involving multiple sites 1
• The development of CRPS does not indicate technical error but rather represents a potential physiological response to surgical trauma

Surgical Dehiscence

• Wound healing complications can occur despite proper surgical technique
• Multiple simultaneous procedures (Lapidus bunionectomy plus hammertoe corrections) increase surgical complexity and wound healing demands

Post-Operative Management Assessment

Standard Post-Operative Care

• Proper post-operative management includes monitoring for complications, appropriate pain control, and early intervention when complications arise 4
• Assessment of negligence would require evaluation of whether appropriate monitoring and intervention occurred once complications were identified

Pain Management Considerations

• Multimodal analgesia is recommended for post-operative pain management 3
• Early recognition and treatment of CRPS is important but does not guarantee prevention or resolution

Conclusion

Based on current medical evidence and standards, the development of surgical dehiscence, incisional complications, and CRPS following a complex foot procedure does not in itself indicate negligence. These are recognized potential complications of foot surgery that can occur despite appropriate surgical technique and care. Negligence would only be established if there was evidence of deviation from the standard of care in the surgical technique, perioperative management, or failure to appropriately respond to complications once they developed.