Famous Patients, Famous Operations, 2005 - Part 3: The Surgeon Who Dramatically Lowered Operative Mortality Rates by Defying Evidenced-Based Medicine

Albert B. Lowenfels, MD

Disclosures

October 10, 2005

Introduction

The surgeon, a 38-year-old man, was professor of surgery at a prestigious university. He belonged to an elite surgical society and was widely respected for his research and teaching abilities. This case report describes how his management of a patient transformed the surgical practice.

Case Presentation: The patient, an 11-year-old boy, was run over by a cart. At the time of admission to a large urban medical center, he was alert, awake, but in considerable pain. Physical examination revealed a compound fracture of the midportion of the left tibia and fibula. There appeared to be no other injuries.

At the time, because of the high incidence of fatal gangrene, the conventional "evidence-based" treatment for open fractures was immediate amputation of the injured extremity. Instead of amputation, the surgeon opted for a highly unconventional approach -- reduction of the fracture and application of a new type of moist protective dressing.

Four days later, when the surgeon changed the dressing, the surgeon, the patient, and the hospital staff were astonished to observe a clean wound with no signs of gangrene. The surgeon noted superficial wound irritation caused by the dressing, but the patient was eventually discharged with a sound, well-healed, functional left leg. A few years later, the surgeon published the results of this and similar cases in a high-impact medical journal.

Who was the surgeon?

  1. Ambrose Pare

  2. John Hunter

  3. William Halsted

  4. Joseph Lister

View the correct answer.

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