Last Minute Decisions and Iffy Results

Last Minute Decisions and Iffy Results

So this morning I made an error. I call it an error, say of judgment, rather than a mistake, because split semantics aside, it came off a gamble I took which didn’t pay off as it should have because of unexpected circumstances beyond my anticipation.  There was this case we had posted for surgery a week (10days?) ago and back then we had reviewed the case and had decided to go for a full thickness (epithelium+ connective tissue+ periosteum) flap. But today when the patient turned up for surgery and was prepped, anaesthetized and ready to be operated on, I took a long, long look at the operating site and my surgical judgment (my intuition?) telling me that with a split thickness flap (a half-way flap) will give better results and also help in preserving the donor site from where I was going to harvest the graft and then stitch it to the new (deficient site), I made the split-second decision to go for the tougher to do split thickness flap instead of the agreed on protocol and proceeded to raise a beautiful split flap. And then came the anti-climax. 

The theatre staff handed me 3-0 sutures which is what they had ready for a full flap while I prefer to use a 5-0 suture (thinner one) to stitch a thinner split flap. Although the theatre IS  supposed to have all sizes of sutures at all times (for all surgeries) somehow they did not have what I wanted right then and I had to make do with the had – a 3-0 size only which dint really fit the thin flap I had taken. So I wasn’t really satisfied with the end result of my surgery and will eagerly wait for next week when the sutures come off to see the result – fingers crossed. 

The thing is I am still in a dilemma about whether I should have stuck to my original surgical plan frozen a week ago or should I have made the call to change the design at the moment of surgery. Do good intentions excuse an error of judgment? What if the gamble had paid off, as it would have if the nurses had properly stocked the operating theatre? There are so many “IF’s” but no clear cut answers. The only thing of certainty is I took a risk and it didn’t come off as it should have – maybe a 70% success rate only- which may be good enough for the patient but still is kinda hurting to my ego. So was I justified in giving precedence to my surgical skill over the team decisions by invoking my privilege as the operating surgeon? The jury’s out till the sutures come of…and till then feel free to pop in with your views on what I should or should not have done.