Reconstructive Surgeon's testimony Sets Up 6-Figure Verdict in motorcycle Crash Case

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Testifying in a 2020 California personal injury trial, Larson v. O’Reilly, et al., Dr. Brent Moelleken, a reconstructive plastic surgeon from Los Angeles, opines concerning the plaintiff’s claim that a motorcycle crash severely injured his foot, as to the damage that occurred. The doctor who had examined the plaintiff, says that originally the patient was having symptoms confined to his toe, but after almost a year he began having problems in the front of his heel also. This is related to the tibial nerve which gives a branch to the big toe and also the front of the heel, the medial plantar nerve. This second area being involved after such a delay, led him to believe that this was actually a type of phantom pain that resulted from continuous toe pain overwhelming the brain thus causing the dysfunction of having pain in areas not affected by the original trauma. This severe and spreading pain causes the release of hormones that constrict the blood vessels supplying the foot. This was a foot that already had impaired blood flow in the small arterioles due to diabetes, and now the larger arteries to the foot were similarly effected due to the pain. Dr. Moelleken explains that the chronicity of the plaintiff’s pain and dysfunction had led to a curling of the toes as the flexed position totally dominated the patient’s ability to extend the toes. The doctor refers to this condition as “hammertoe”. An ulcer developed on a joint of the second toe because of this hammertoe rubbing against a shoe and in a patient with a poor blood supply, this not only provides an environment conducive to infection, but threatens the entire foot. Ordinarily this medical condition of hammertoe is treated surgically by removing a segment of bone or removing the joint. This is problematic first because it results in a flaccid toe, and in this case there is extreme risk due to the poor blood supply to this area. He has “less than 50%” chance of this healing, so partial amputation is not expected to heal properly. The expert explains that a prosthetic would protect the second toe from curling over the adjacent toe, but does nothing for hammertoe. It will not allow the intrinsic or extrinsic muscles to lift a toe effected like this, or allow the toe to push off the ground. Discussing more fully the role played by prosthetics in amputations, the doctor’s testimony explains that no prosthetic will assist in the foot pushing off of the ground. The lack of a functional toe therefore prohibits one from pushing off and effects the overall balance. When amputations are performed, there will always be some degree of functional deficit. It is important to be able to inform the patient of expected limitations. Consideration of the level of the amputation is extremely important to the patient for the rest of their lives. “Every day that he’s missing his toes is a day that he cannot balance properly” and it is mentally “upsetting” to look down and see that your toes are gone. Having followed the plaintiff for more than a year, the reconstructive expert tells the jury that his patient is getting worse, and he expects that he will have to undergo further amputations in the future. Presently, since the first toe is missing, he walks with his foot curved to that side. The second toe is a hammertoe and therefore functionally not a useful toe. He considers that this patient has therefore functionally lost two toes, and remarks that, “Once you lose enough toes, it ceases to be a functional foot.” The testimony in this clip concludes with a discussion about how the amputation level would be determined in this case. The doctor says that once the toes have been compromised as they have, a transmetatarsal amputation, or amputation of the forefoot across the long bones of the foot would ordinarily be the best level of amputation. But that may not be so in this case because the initial crush injury altered the blood supply through the heel leaving a post op stump that would be unlikely to heal. After a seven day trial, the jury awarded the plaintiff $615,000. -- Gary Gansar, MD, is residency trained and Board Certified in General Surgery. He previously served as Chief of Surgery and Staff at Elmwood Medical Center and on the Medical Executive Committee at Mercy Hospital and Touro Infirmary in New Orleans, LA. Dr. Gansar also served as Clinical Instructor and Professor of Surgery at Tulane University. He received his MD and served as Chief Resident at Tulane University Medical School. Dr. Gansar joined AMFS as a consulting medical expert in 2011 and has served as Medical Director since Nov. 2015. In this capacity, Dr. Gansar provides consultation, review and guidance to attorney clients.

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