Transferring patients after complications of treatment

A fifty-four-year-old woman who had diabetes mellitus was involved in a motor-vehicle accident. She was taken to the emergency department of a small community hospital in a rural town, where it was determined that she had sustained a comminuted fracture of the proximal portion of the femur. She underwent an open reduction and internal fixation of the femoral fracture, which was followed by the development of a deep wound infection that required multiple operative débridements and removal of the fixation device. The wound tissue appeared healthy, and there was no histological evidence of infection. However, the patient was left with a large soft-tissue defect and a 3-in (7.62 cm) bone deficiency. The surgeons at the community hospital were not trained in microvascular reconstructive surgery and attempted to transfer the patient to a larger, urban teaching institution for further care. Four separate institutions were contacted. All declined to accept the patient. The patient was eventually cared for by a trauma surgeon at a local private hospital.