Mr Marco Scarci Consultant Thoracic Surgeon · Expert Witness Discuss a case

Chest wall & trauma

Chest wall deformity and post-surgical outcome

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Chest wall surgery is a specialist area within an already specialist field, performed in a small number of centres, and increasingly performed privately. Claims arising from it are frequently sent to experts who do not perform the operations. I do.

Where these claims come from

Five categories of work

Minimally invasive repair, open repair, and bracing. Claims arise from bar displacement, bar infection, cardiac and pericardial injury, inadequate correction, recurrence after bar removal, persistent pain, and the adequacy of consent — particularly where the procedure had a substantial cosmetic component.

A growing category. Whether the patient was an appropriate candidate, whether the limitations of the result were explained, whether alternatives including conservative management were discussed, and whether the outcome achieved falls within the range that should have been anticipated.

Following tumour resection, trauma or infection. Failure of reconstruction, prosthesis complications, flap problems, and paradoxical chest wall movement.

Adequacy of resection margins, appropriateness of the reconstruction, and the consequences of under-resection or over-resection.

A condition frequently missed for years and then, when finally identified, surgically treatable. Claims arise both from failure to diagnose and from the outcome of surgery once undertaken. I have a particular clinical interest in this group.

Consent in chest wall surgery

First

The benefit sought is often appearance Where the indication is partly or wholly cosmetic, the standard expected of the consent discussion is correspondingly higher, and the alternatives — including doing nothing — have to be canvassed properly.

Second

Many patients are young Many of these patients are young, and some are adolescents. Consent involving a minor, the assessment of capacity, and the involvement of parents raise issues that do not arise in most thoracic practice.

What I can advise on

Scope of opinion

Whether the patient was an appropriate candidate for the operation performed Whether the operation was performed to an acceptable standard Whether the outcome falls within the range that should have been expected Whether the consent discussion met the required standard, including the discussion of cosmetic expectation and of alternatives Whether complications were recognised and managed appropriately What revision surgery is available, what it would achieve, and what it would cost — frequently the largest head of quantum in these claims Condition and prognosis, including chronic pain and restriction

What I will need

Records

  • Full clinical record, including all pre-operative clinic correspondence
  • Pre-operative photographs and imaging
  • The operation note
  • The consent form and any information leaflets or written material given to the patient
  • All post-operative imaging
  • The patient’s own account of what they were told to expect

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