Nerve damage due to positioning during surgery

Compartment syndrome after complex bowel surgery. Claim against leading expert and centre of excellence. Adoption of unique operating position without risk analysis or peer review. New defence argument only surfacing at trial dismissed. Judge criticises defence experts. Usually, a compartment syndrome case involves an allegation of delay in diagnosis and treatment. In this case, there was prompt diagnosis aided by the immediacy and magnitude of the compartment syndrome which was described as being equivalent to a crush injury. It is probable that the increased weight on the calves while the patient was in the low Lloyd Davies position combined with a lack of perfusion and acidosis in the first part of the operation caused an ischaemic injury in a patient who was at risk due to his size and muscle structure; the Trendelenburg position adopted in the second part of the operation is known to cause compartment syndrome but this patient already had ischaemia before the operation reached that stage. Reperfusion at the end of the operation caused the immediate damage and in spite of prompt reoperation the patient suffered a desperately severe illness and subsequent permanent disability. This case illustrates how a Claimant can succeed even against a renowned international surgeon and a centre of excellence if in spite of his outstanding reputation the surgeon fails to keep abreast of medical developments or consider the impact of his ‘invention’ on a particular patient. A position of high repute within a profession, whether institutional or personal does not provide protection from the legal tests for breach of duty.