This is a single institution review of litigation filed from 2001-2009 related to hand/finger amputations that resulted in successful replantation, unsuccessful replantation, or amputation revision. The article nicely discusses the generalities of malpractice law and the process by which malpractice is filed and adjudicated in the state of New York. During the study review period, 219 digits in 168 patients had attempted replantation/revascularization due to trauma with 23 return trips to the operating room for vessel exploration with 11 replant failures and subsequent amputation revision. Of note, 523 amputation revisions were performed without attempt to replant/revascularize during the same period. Six hand replantations were also performed with one failure. During that time period, 23 patients filed malpractice claims. Five of the 23 claims belonged to patients with failed attempts at replantation/revascularization (21%). Thirteen of the 23 claims were brought by patients with primary amputation revisions due to the decision not to replant (57%). No claims were filed by hand/wrist level replants. One suit was due to shoulder dislocation while moving the patient with a history of multiple shoulder dislocations, 3 patients claimed improper treatment due to either tissue loss, malunion, or flap failure, and one patient filed suit because the amputated part was discarded which prevented seeking a second opinion. Of all suits filed, no suit proceeded to trial. Only one suit was settled ($45,000), and this was the suit involving the discarded amputated part preventing a second opinion.
Overall, the results of this study show that surgeon’s actions are typically defensible whether replantation has been performed or not when proper documentation has been provided. Only a single case resulted in payment and that was for an error of tissue handling logistics. The authors note that patient-surgeon communication and effective documentation are the most important issues in preventing litigation. Straightforward communication may decrease the chances of a patient filing suit while complete documentation tended to keep lawsuits ever from progressing from their preliminary stages. A more costly case from another institution is used to highlight how differences in communication, even between physicians in the ER and hand consultants, expediency of evaluation and care, and documentation can make all the difference.