One of the biggest medical stories of last week involved an unusual case from Scotland.
During the course of a leg amputation at Ayr Hospital in Scotland, the surgeon discovered a metal plate in the patient’s leg. Lacking the proper instrumentat to cut through the plate, the surgeon sent someone to a local hardware store, which unfortunately was closed as the operation was taking place after hours.
Here’s where it gets weird. While the staff was frantically searching for a suitable instrument, a rusty hacksaw was found in a storage closet. According to a report, it was disinfected by soaking it in an antiseptic solution and used to help complete the procedure.
Operating room personnel brought the incident to the attention of the hospital’s administration, but the patient and his family were not told about it until sometime later.
A Scottish Conservative healthcare spokesman said, “This is simply incredible—an indescribable way to treat any patient. Despite the UK’s advances in modern medicine, this episode has all the finesse of improvised surgery on Nelson’s flagship during the Battle of Trafalgar.” [For you non-history buffs, that event took place in 1805.]
The outcome of the surgery was not stated, but apparently the patient did not develop a complication.
The obligatory investigation is underway. The interim nursing director of the hospital said “NHS Ayrshire and Arran is currently conducting a significant adverse event review into a recent incident within University Hospital Ayr, where standard procedures were not followed.”
What would the standard procedure be for discovery of a previously unknown metal plate in a leg during an amputation?
The real problem is human error. The patient had been transferred from a smaller hospital to the vascular surgery service at Ayr Hospital. Perhaps if a proper history and physical examination had been done, the patient might have mentioned the previous orthopedic surgery or a scar on the leg might have been discovered.
Some folks on Twitter wondered why the incision was not simply closed with a plan to take the patient back to the operating room when appropriate instruments were on hand.
It’s not so simple. By the time you get to the point of dividing the bone during an amputation, most if not all of the nerves and blood supply to the part of the leg being removed have been cut and tied off. Closing the wound would be risky because the leg beyond the incision would begin to rot immediately.
If this event is deemed due to a system error, would the plan of correction be “Do not perform amputations on patients when hardware stores are closed”?
Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and critical care and has re-certified in both several times. He blogs at SkepticalScalpel.blogspot.com and tweets as @SkepticScalpel.