Case of the month: Tummy tuck complication

...Mrs H claims Dr R failed to warn her of possible complications and offered no preoperative advice on smoking cessation...

Background

FIVE months of intensive dieting have left Mrs H three stones lighter but still unhappy with the appearance of her abdomen. She attends a plastic surgery clinic for cosmetic abdominoplasty where she discusses the procedure with Dr R. Mrs H decides to go ahead with surgery, and Dr R operates a few days later.

The operation goes well but Mrs H develops postoperative flap necrosis. Conservative treatment fails and another operation is required to remove the necrotic tissue and apply a skin graft, with resultant scarring.

A few weeks later, a solicitor's letter is received by the private clinic alleging clinical negligence. Mrs H claims Dr R failed to warn her of possible complications and offered no preoperative advice on smoking cessation - smoking being a known risk factor for postoperative necrosis in abdominoplasty.

Analysis/outcome

Dr R contacts MDDUS for advice and an adviser asks for a copy of his patient notes. Unfortunately the surgeon has failed to record exactly what was said in the consultation.

The lack of an adequate contemporaneous clinical record means Dr R is unable to offer documentary proof that Mrs H had, in fact, been informed of possible post operative risks, including flap necrosis, and counselled to stop smoking prior to the operative procedure. After further negotiations, the case was settled.

Key points

• Pre-operative advice regarding possible complications must be given.

• Record the advice given in case of a future dispute.

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