Limb ischaemia amputation claims

Ischaemia is the medical term for a reduction in the blood supply that carries oxygen to the tissues of the body. Unless the blood and oxygen supply is restored quickly, the tissues become damaged and die (necrosis).

Limb ischaemia is a serious medical condition in which the oxygenated blood supply to a person’s limb, (arm, hand and fingers or leg, foot and toes) is restricted or reduced.

When the blood flow to an arm or leg is reduced suddenly and severely, such as by a blood clot causing a deep vein thrombosis (DVT), or by an injury, surgical wound, or inflammation from infection, this is known as acute limb ischaemia. Acute limb ischaemia is a medical emergency and must be treated urgently to restore the blood flow to the affected limb.

Limb ischaemia can also develop over time as a result of peripheral arterial disease (PAD). PAD can be caused by smoking and lifestyle factors, and health conditions, such as atherosclerosis, high blood pressure (hypertension) and diabetes. Patients with chronic limb ischaemia from these conditions may experience complications, such as leg pain and ulcers. PAD must be treated as it increases the risk of serious complications of cardiovascular disease, such as heart attack and stroke. If untreated, the blood flow to the legs can become severely restricted, causing severe pain, ulcers and gangrene from critical limb ischaemia (also known as chronic limb-threatening ischaemia), which may only be treatable by amputation.

Limb ischaemia, or the reduced supply of oxygenated blood to a limb, is caused by blockages or narrowing of the arteries through which the blood circulates to the limbs. Prolonged or untreated limb ischaemia causes necrosis (death) of the tissues and gangrene. Amputation may be needed to prevent the gangrene from spreading.

Acute limb ischaemia is caused by sudden restriction of the blood flow to the limb, such as from a blood clot, thrombosis or embolism (VTE); a surgical injury to the artery; or a traumatic injury from an accident or impact. Sudden loss of blood supply to a limb may also be caused by inflammation and swelling from other serious conditions, such as compartment syndrome, anaphylaxis (severe allergic reaction), and severe infection or sepsis.

Critical limb ischaemia or chronic limb-threatening ischaemia is a severe form of peripheral arterial disease (PAD), which is caused by a build-up of fatty deposits inside the arteries (atherosclerosis), which narrows the arteries and restricts the blood supply to the limbs.

The blood circulation to the legs can also be affected by diabetes, hypertension (high blood pressure), smoking, high cholesterol and other lifestyle factors.

Acute limb ischaemia is a medical emergency. Without urgent treatment to restore the blood supply to the affected limb, the patient can suffer irreversible tissue damage within six hours. Untreated critical limb ischaemia can cause severe pain, necrosis (death) of the tissues, ulcers, severe infection and gangrene, and increases the patient’s risk of life-threatening cardiovascular conditions.

Limb ischaemia may be treated by medication (to prevent blood clots or lower blood pressure or cholesterol), endovascular treatments (such as angioplasty to open a blocked artery) or surgery. However, when there is life-threatening infection, irreversible tissue damage which cannot be salvaged by medical or surgical treatment, or there is gangrene in the affected limb, amputation may be necessary to prevent the gangrene from spreading, to control the condition and to preserve as much of the patient’s remaining limb function as possible .

The level of the patient’s amputation will depend on how far the necrosis (dead tissue) or gangrene has spread. The amputation surgery will also aim to preserve the patient’s ability to use a prosthetic (artificial) limb in future.

Our amputation claims solicitors are skilled in securing substantial compensation in medical negligence claims for clients who have suffered below-knee amputations, above-knee amputations, Lis-franc and foot amputations, upper limb and hand amputations, and multiple amputations.

Medical negligence claims for amputation injury from limb ischaemia often involve one or more of the following negligent mistakes:

• failing to assess the patient’s risk of VTE (blood clots, thrombosis, embolism);
• anticoagulation errors for patients at risk of thrombosis or venous thromboembolism (VTE);
• failing to take a proper medical history of the patient’s signs and symptoms;
• delay or failure to recognise the signs of limb ischaemia;
• delay or failure to refer a patient for urgent treatment for limb ischaemia;
• delayed revascularisation procedures (e.g. angioplasty);
• delayed diagnosis of compartment syndrome;
• delays in surgery;
• incorrect surgical technique or surgical injury;
• incorrect post-operative care.

Limb ischaemia amputation claims usually arise from GP, hospital or emergency care negligence which has resulted in the patient suffering one or more amputations to their arms and hands, or legs and feet. In addition to their physical injury, many limb ischaemia amputees experience phantom limb pain and psychological injury. They may also be left with an increased risk of further amputation or other life-threatening complications, such as heart disease or stroke.

The amount of compensation that an amputee can claim in a medical negligence claim for limb loss from limb ischaemia will depend on the circumstances of their injury and the impact that their disability has on their life. Claims for amputation caused by medical negligence often include compensation for expenses and losses including:

• pain, suffering and disability;
• specialist prosthetics (artificial limbs, hands, feet);
• private medical and surgical treatment and rehabilitation;
• therapies (physiotherapy, occupational therapy (OT), pain management, psychological counselling);
• adapted vehicles, wheelchairs and specialist equipment;
• home adaptations;
• care and domestic assistance;
• financial losses, such as loss of earnings and pension;
• other costs and expenses arising from their disability.

In cases where the medical negligence has resulted in injury but has also left our client at risk of needing an amputation in future, we can protect their right to claim further compensation if the anticipated future amputation occurs by making a claim for provisional damages. This means that our client receives a compensation settlement for the injury they have already suffered, but can return to court for more compensation at a later date if the anticipated amputation takes place.

Compartment syndrome is a painful and serious condition in which a build-up of pressure around the muscles within a closed fascial ‘compartment’ in the body restricts the blood flow and oxygen to the muscle tissues and nerves, causing ischaemia. Compartment syndrome can affect any group of muscles, including the arms, abdomen and buttocks, but is most common in the lower leg.

Acute compartment syndrome happens suddenly, often after a traumatic injury which causes bleeding, swelling and increased pressure within the muscle compartment. It can also be caused by complications after surgery, such as wearing a cast that is too tight or prolonged pressure on a limb that has been immobile for some time.

Acute compartment syndrome is a medical emergency and requires urgent diagnosis and surgical fasciotomy to release the pressure within the fascial space. Delays in diagnosis and surgical treatment can cause irreversible damage to the muscles, resulting in loss of function, necrosis (tissue death), gangrene, and amputation of the limb. Patients with untreated acute compartment syndrome suffer limb-threatening injury within a few hours. Untreated acute compartment syndrome can also lead to the patient’s death.

Chronic compartment syndrome builds up slowly over time and is often related to intense physical activity or exercise. Unlike acute compartment syndrome, chronic compartment syndrome can usually be managed with physiotherapy, orthotics and changes to the patient’s exercise regime. In some cases, chronic compartment syndrome may need treatment with surgery.