Josephine
Joslin
Standing outside early one Monday morning in April, two-year-old Josephine Joslin asked her dad to open the garage door so she could get her toys out. As David Joslin turned to hit the control button, Josephine grabbed the door handle.
Joslin heard Josephine scream and turned around in time to see her being pulled up with the opening door. He tried to cancel the opener but couldn't. He then raced to grab her, but by the time he got to the door, Josephine was dangling in the air.
“How her head missed hitting the header beam of the garage is a miracle No. 1,” Joslin said. “The door finally stopped and I got her down, not yet realizing her finger had been injured.”
As Joslin carried Josephine into the house, he still didn't see that her finger was cut. “I thought she was crying from sheer fear,” he said. “But when I sat her down on the kitchen counter, I saw the blood. Her right index finger was attached to her hand by only a minuscule piece of tendon.”
When she grabbed the hollow metal handle of the garage door, Josephine's tiny index finger had lodged in a small opening.
Joslin acted quickly, packing her hand in a bag of ice. He got Josephine and his four-year-old son Jake into the car and headed for the emergency room at Hilton Head Hospital. On the way, he called his wife Karen, who was driving to work, and told her Josephine had been hurt.
A plastic surgeon at the hospital felt if there was any to save the finger, it would be with special surgery available at MUSC. Given a small ray of hope, the Joslins decided to make the trip to Charleston. Josephine's hand and arm were secured on an arm board for the two-hour drive. “The drive gave us time as a family to reconcile ourselves to the fact that Jo might lose the finger,” Joslin said. “I remember thinking if any child could handle this, Jo could. She's a survivor.” But once at MUSC, Josephine's prospects looked brighter.
“When Karen's boss heard about the accident, he offered his company plane to take Josephine wherever she could get the treatment she needed,” Joslin said. “But the admitting nurse in the emergency room said that wouldn't be necessary, because the surgeon she needed was right there at MUSC.”
John McFadden, M.D., a specialist in hand and microsurgery, determined that Josephine's finger had not been cut, but pulled away from her hand. “The blood supply to her finger had been destroyed, leaving it attached only by a damaged tendon,” he said. “The injury was such that I needed to make the decision in the operating room on whether the finger could be saved.”
McFadden explained to the Joslins how he needed a microscope used in surgery to look for a viable artery in Josephine's finger. Operating on small children is technically very challenging, he said. For example, the vein he took from Josephine's foot to revascularize her finger measured only 0.4 millimeters in diameter, which is about the size of a strand of dental floss.
The surgery took five hours. “We were able to do a complete replantation, and she has healed very well,” McFadden said.
Josephine spent a restless week in the hospital. “Her arm hung in a sling above her head for three days to keep her injury above her heart, and an IV was inserted in her other arm,” her mother Karen Joslin remembers. “It was difficult for an active child like Jo to be in that position for so long.”
For three weeks after she went home, Josephine had a pin in her finger and wore a cast that went all the way up to her shoulder. When the cast came off in May, she was healing well, and flexibility was returning to the finger.
McFadden is still watching Josephine's recovery to make sure her bones continue to grow normally. In June, 80 percent of the finger's flexibility had returned, but it will be a year and a half before McFadden can judge whether bone growth is normal.
“The combination of Jo's attitude, Dr. McFadden's skill and the good Lord watching over us brought about her recovery,” Joslin said. “We felt as if everyone at MUSC—from the ambulance drivers who opened the emergency room door for us, to the people who sweep the halls at night—had the attitude that they were there to help us and our daughter.” Editor's note: The article is reprinted from Checkup newsletter, produced by MUSC Creative Services.