Parents fear nothing more than sudden, serious injuries to their children. But as we report each year during our holiday-season fund-raising campaign, Children's Hospital treats injuries calmly and skillfully. My associate, Alexandra B. Stoddard, has the story of a farm accident that might have been far worse if a Children's surgeon hadn't saved the day:
Two-year-old Chad Kinsey was playing on the front lawn of his Front Royal, Va., home in the late afternoon of May 18 when he slipped and caught his right hand and right leg in the mower deck of the tractor his mother was driving in the yard.
Chad's mother, Elaine Kinsey, recalls that when she was able to stop the tractor and free her son's limbs from the blades, Chad was not crying. "It hurts," she remembers him saying. "The tractor hurt me."
Chad's parents drove him to the emergency room at Warren Memorial Hospital in Front Royal, where he was examined immediately. Doctors there cleaned his wounds and gave him antibiotics and morphine intravenously. But they recommended that he be transferred to Children's Hospital by helicopter right away. Elaine Kinsey said she and her husband, Bill, were "in a state of shock."
Within 20 minutes, a helicopter arrived. It took Chad and his mother to Children's while Bill Kinsey made the trip by car. According to his mother, Chad was conscious and relatively calm during the 18-minute flight.
When Chad arrived at the Children's emergency room, he was seen by Dr. Laura Tosi, a general pediatric orthopedic surgeon. According to Dr. Tosi, Chad had lost the fourth and fifth fingers on his right hand when he reached under the tractor to pull his foot out from under it. The blades had also cut skin and fat from his right calf and had severed most of his right heel pad.
Lawnmower and tractor injuries are among the dirtiest doctors face. Because of grass, animal feces and pesticides, they carry with them the greatest potential for infection.
Therefore, Dr. Tosi first cleaned the wounds as thoroughly as possible. Then she concentrated on saving the heel pad.
While Chad was in surgery, his mother was met by Cyndy Wright, the trauma rehabilitation coordinator at Children's, who introduced her to a social worker and guided her through the admissions process.
"I had no I.D., and I had blood all over me. I looked terrible," Elaine Kinsey recalled. "I had nothing to verify my insurance. But they never hesitated to do what they had to do to treat him. The rest was secondary to them."
Chad's stay at Children's lasted from May 18 to June 22. During that time, he underwent reconstructive surgery to repair the nerves in his hand. He also celebrated his third birthday in the hospital -- on June 15.
Doctors determined that the extensive soft tissue loss and nerve damage threatened the sensibility and coordination in the rest of Chad's hand. So Dr. Michael Boyajian, chairman of plastic and recontructive surgery at Children's, performed a microvascular free-tissue transfer, which doctors call a "free flap".
This procedure involved covering the damaged nerves in Chad's hand with live tissue from his back. The transplanted tissue provided a blood supply so that the nerves could heal. The operation, which took place on May 24 and lasted eight hours, was so successful that Chad can now use his hand almost as fully as he could before his accident.
Chad can play with building blocks and puzzles, zip and unzip his fly, hold a pencil, open doors and use silverware. Dr. Boyajian says that Chad is a candidate for thumb reconstruction and that his prognosis is promising.
"The disability that this child looks forward to is very, very small," he said.
According to Dr. Boyajian, most hospitals can perform microsurgery but it is rarely attempted on children because of the size of their blood vessels.
"There are very few places that are going to attempt it on a child. But for us, it's very routine," said Dr. Boyajian. "We made decisions based on knowledge and confidence that it would work."
The Kinseys are grateful to know that Children's will always be a place where Chad and other seriously injured toddlers can count on receiving the best care.
"I hope that other parents don't have to go through what we went through to find out about Children's," said Elaine Kinsey. "But the fact that we have a facility like that where they do the things that they do is really amazing."
TO CONTRIBUTE TO THE CAMPAIGN:
Make a check or money order payable to Children's Hospital and mail it to Bob Levey, The Washington Post, Washington, D.C., 20071.
THE CAMPAIGN ENDS ON JAN. 18.