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Saving Devin's Hand

DevinDevin Graham’s mom calls him a trooper. He lived up to that name when just five days before his 13th birthday, the Wichita, Kan., boy sustained a major trauma to his hand that brought him by airplane to St. Louis Children’s Hospital for emergency surgery.

Devin, who had never left his home state, been hospitalized or flown in an airplane, now has some stories to tell his friends back home.

“I had picked up Devin from school when we were driving home and saw a man we didn’t know who had a work wagon stuck in the mud,” says Devin’s mom, Marla. “We offered to help, and we were both holding onto a rope to help pull the wagon.”

So Devin could get a better grip, he wrapped the rope around his hand and his index finger a few times. Unfortunately, when the man accidentally tapped his gas pedal too hard, the pulling of the rope led to a near amputation to Devin’s right hand.

Although Marla had broken her own finger, her first thought was Devin. Since they were five minutes from a local hospital, she drove him there herself and the emergency department staff immediately realized they did not have the ability to save Devin’s hand.

“I was crying the whole time and didn’t even think about my hand, which just had a broken pinkie,” Marla says. “Life’s been pretty tough on us lately, but Devin never cried at all. It was less than an hour after we got to the hospital and he was on a plane for St. Louis with my nephew who rode with him.”

The local emergency room doctor had called several hospitals and found that the doctors at St. Louis Children’s Hospital were the only ones who would agree to try to save Devin’s hand. If not, he would have lost everything but his thumb.

“I received the call from the emergency room doctor in Wichita around 4:30 p.m. and was sent a photo of the injury,” says Charles Goldfarb, MD, Washington University physician and pediatric orthopedic surgeon. “By 11 p.m. that night, Devin was in surgery until about 4 a.m.”

Dr. Goldfarb and his colleagues in orthopedics, including Martin Boyer, MD, Richard Gelberman, MD, Ryan Calfee, MD, Lindley Wall, MD, and Daniel Osei, MD, have expertise in pediatric finger and hand replantation. Additional surgeons who perform hand replantation at St. Louis Children’s Hospital include plastic and reconstructive surgeons Keith Brandt, MD, Ida Fox, MD, Amy Kells, MD, PhD, Thomas Tung, MD Amy Moore, MD, and Alison Snyder-Warwick, MD.

St. Louis Children’s Hospital is the only pediatric trauma center in the region and one of the few in the Midwest with this type of expertise.

Because Devin’s fingers were still attached the procedure was not technically a replantation, Dr. Goldfarb says.

His hand had five broken bones and all of the arteries were severed, but because the tendons were intact, it was not a “true” amputation, Dr. Goldfarb was able to perform a revascularization and a stabilization of the fractures.

During the procedure, Dr. Goldfarb removed the unhealthy tissue and repaired the five fractures with K-wires, or pins, to hold the bone fragments together. An operating microscope was used to repair the arteries and veins to allow for blood flow.

“A rope injury is a different type of injury than cutting your finger with a knife because the rope causes a wide zone injury and so it can be tricky,” he says.

Because the rope was double wrapped around Devin’s index finger he may not have fully restored motion or feeling in the index finger due to the extent of the injury. But, overall, Dr. Goldfarb expects his prognosis to be good thanks to his young age together with physical therapy and time.

Devin remained in St. Louis Children’s Hospital for a little more than a week following his surgery. He was put on a blood thinner and actually was treated with medical leeches that are used to suck out extra blood and make a chemical called hirudin, which helps stimulate blood flow, Dr. Goldfarb explains.          

“The nurses and doctors were excellent at St. Louis Children’s Hospital,” says Marla, who made the 16-hour roundtrip between Wichita and St. Louis three times by car with Devin’s older siblings. “I always knew they were taking good care of my boy, and they were excellent at keeping me up to date. They saved my baby.”

As for Devin, he says the nurses and doctors were nice, especially Dr. Goldfarb, and he’s happy his hand was saved so he can keep playing the videogames he loves.

“My babies have always had angels,” says his mom. “Devin did for sure.”

 

Orthopedics