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What Can Go Wrong

While the following discussion is usually one of the most intimidating and frightening aspects of surgery, it’s also one of the most important. All surgery is associated with certain risks that something can go wrong. When this happens, the problem is called a “complication.” Sometimes patients think that doctors tell them about potential complications for legal reasons. This is incorrect. There are two main reasons why it’s important for you to know about potential complications. The first is so that you can be fully informed and educated as you decide whether or not to have surgery. I rarely tell patients that they “need surgery.” Rather, I tell them how surgery might help, and that they must weigh this against the potential risks of surgery. The second reason to be familiar with potential complications is that if a complication does occur, it can be recognized and addressed as soon as possible. Big problems usually start as smaller ones, and it is often much easier to treat a complication sooner rather than later.

So, what can go wrong? For starters, there is always the risk of infection. The skin is an amazing barrier that protects us from bacteria. With any surgical incision, the inner body is exposed to bacteria and an infection can develop. Most infections are shallow, or “superficial”, and are treated with antibiotics. Less commonly, the infection is “deep,” and requires another surgery to clean the infected tissues. Before any operation, numerous steps are taken to protect against infection. My colleagues and I have even performed research on how to optimally clean the foot and ankle before surgery. Nevertheless, there will always be some risk of infection. Fortunately, for most foot and ankle procedures, this risk is very low, and less than 5%.

In addition to infection, there is also a risk of nerve injury during surgery. In the thigh, where the circumference is much larger, there are two main nerves. Down towards the ankle, where the circumference is smaller, these two nerves split into five smaller nerves. As such, there is a greater chance that these nerves can be stretched, bruised, or even cut during surgery. Such injuries can result in loss of sensation, weakness, and the formation of a neuroma. A neuroma is a region of an injured or irritated nerve that becomes hypersensitive and painful. In order to minimize the chance of nerve injury, several steps are taken, including careful positioning of incisions and delicate handling of soft-tissues.

Along these lines, surgical patients can infrequently develop a syndrome previously called Reflex Sympathetic Dystrophy (RSD), now called Chronic Regional Pain Syndrome (CRPS). CRPS is characterized by pain that lasts much longer and is more severe than normally expected. It may also be accompanied by painful sensations to touch or other non-painful stimuli, as well as changes in skin temperature, color, vascularity, and hair growth. The ultimate cause of CPRS is unknown, as is an understanding of which patients will be affected by it. Please be reassured that CRPS is relatively uncommon (it is estimated to be less than 1% in our practice). Nevertheless, we watch for it carefully as in the vast majority of cases it can be successfully treated.

In addition to these complications, there are unfortunately other risks associated with surgery. These include bleeding, drug reactions, and blood clots. It is very important that you inform the surgical and nursing staff if you have had any drug reactions or allergies in the past. It is also important to inform the staff if you have had a blood clot in the past. If so, you may need to take blood thinners after surgery.

Finally, with any procedure, there is always the possibility of an unexpected complication, and no guarantees or promises can be made concerning the results of any operation. Please be assured, however, that we do everything possible to prevent complications. We also strive to treat them as aggressively as possible should they develop. And again, the potential complications listed above are not reviewed for legal reasons. Rather, they are reviewed to help you make an educated decision with regard to surgery and to familiarize you with these complications so that they can be identified as soon as possible.