This case involves the incorrect use and positioning of a continuous passive motion device on a patient’s leg following a total right knee replacement surgery. The medical records showed that the patient’s leg was placed into the device without a foam boot and, as a result, her leg was not maintained in a neutral position while the device was in operation. Furthermore, the patient was not given a control to stop the device, which caused the patient to receive therapy for longer periods than originally intended. The patient was discharged from the hospital with an area of redness and induration that eventually progressed to a full thickness wound. The patient had to undergo several rounds of surgical debridement and extensive, year-long treatments by a plastic surgeon to close the wound. An expert in decubitus ulcer care was considered to opine on this issue.
Question(s) For Expert Witness
1. Should this problem have been noticed before discharge, and what are the earliest signs to identify skin damage before it becomes a serious issue?
Expert Witness Response E-000055
Providers working with persons at risk need to be able to recognize skin changes that might indicate an impending breakdown. This is particularly true in elderly patients or in patients who are immunocompromised because the signs of impending or fulminating infection are frequently absent in these patients. Systemic signs of infection that mark the need to culture wounds include malodorous drainage, leukocytosis, fever, hypotension, increased heart rate, and changes in mental status. The earliest clinical evidence of damage to the skin is inflammation of the skin that blanches on application of digital pressure. This process originally presents like a hyperemic response, however, unlike hyperemia, the inflammation persists longer. Prevention of progression to more serious damage requires immediate, complete elimination of pressure to the involved area.
About the author
Michael Talve, CEO
Michael Talve stands at the forefront of legal innovation as the CEO and Managing Director of Expert Institute. Under his leadership, the Expert Institute has established itself as a vital player in the legal technology arena, revolutionizing how lawyers connect with world-class experts and access advanced legal technology. Michael's role involves not only steering the company's strategic direction but also ensuring the delivery of unparalleled intelligence and cutting-edge solutions to legal professionals. His work at Expert Institute has been instrumental in enhancing the capabilities of attorneys in case preparation and execution, making a significant impact on the legal industry's approach to expert consultation and technological integration. Michael's vision and execution have positioned the Expert Institute as a key facilitator in the intersection of law and technology.
