At the Worst Time, the Best Team

Alexandre Acra

An accidental injury can be a scary thing for a child and parent. So when 3 year-old Alexandre Acra cut his forearm on a broken window, staying calm was a challenge. But knowing what to do—and where to go—wasn’t. “The first thing that came to my mind,” recalled his mother, Catherine, “was Lucile Packard Children’s.”

After ensuring that his bleeding was under control, paramedics drove Alexandre and his father, Roland, to the hospital. The Marc and Laura Andreessen Pediatric Emergency Department, run jointly by Lucile Packard Children’s Hospital and Stanford Health Care, was not only the closest choice for Alexandre, it was the best choice, with a team and setting designed especially for children.

In Lucile Packard’s pediatric emergency department, Roland found a staff of experts “clearly used to dealing with children.” A comfort to both him and his son was a computer preloaded with children’s videos in the room where they waited and where Alexandre would soon be stitched up. “Having Nemo to keep Alexandre’s mind off his wound was a huge help,” said Roland. “From the moment things kicked into action,” he recalled, “I felt we were in very excellent hands.”

Because of his condition, Alexandre’s case was a priority. David Hay, MD, a fourth-year orthopaedic surgery resident specializing in hand and upper limb surgery, carefully examined him. He found that Alexandre’s tendons and nerves were severed and damaged. “He was a brave little guy,” Hay recalled, “and surprisingly calm.” After stitching up Alexandre’s wound temporarily, Dr. Hay explained that Alexandre would need to come back for surgery.

“Even though the surgeons were completely booked,” said Catherine, “they made room for us.” Alexandre’s surgeon would be Amy Ladd, MD, chief of Lucile Packard Children’s Pediatric Hand Clinic and the Robert A. Chase Hand & Upper Limb Center at Stanford. Ladd explained that tendons begin to retract when they are severed. The longer you wait to do surgery, the harder it is to repair them.

The Acras were delighted to have Ladd on their side. “She’s not just the best pediatric hand surgeon in California,” said Catherine. “She’s one of the best in the world.” Plus, “she spoke to us in French, our first language, which wasn’t necessary but made us feel at home.”

The surgery would require repairing two major nerves and a finger tendon in Alexandre’s hand. The team would also patch a large laceration to his wrist tendon by removing a small amount of healthy tendon from another location on his body. Because he sucks his thumb on his left hand, the team avoided that arm. They took the tissue they needed from his right arm near the surgical site. The delicate repair of his nerves required microscopic surgery with specially designed tools for the smallest detail work.

“Children have a tremendous chance of recovery after repair, compared to the same injury in an adult. So the odds were very much in Alexandre’s favor,” said Ladd. “However, the level of complexity required to do the repair is not offered at every hospital, and most hand surgeons don’t work on children. So they send them to us. There is nothing we can’t take care of.”

After assisting in Alexandre’s surgery, Dr. Hay explained his recovery plan: a full arm cast for at least 30 days, and then a splint for 4 to 6 weeks, and several weeks of rehabilitation. “Dr. Ladd does a great job of organizing care so that patients are more likely to see the same resident over the course of their treatment, whenever possible,” he said.

“Occupational therapy for children is all about making the exercises fun, using activities that the kids already enjoy,” said Chan. “Our focus is not just on restoring range of motion and strength, but helping children use these abilities for things that are meaningful to them.”

From their first arrival at the emergency department to their last visit to the rehabilitation department, the Acra family was delighted with the care they received. “It wasn’t just the operation for us,” said Catherine. “It was the whole follow up. They take care of you from pre-surgery through weeks and weeks afterward. They hold your hand—literally!—the entire way.”