CALEB'S COMEBACK; 4-YEAR-OLD TAKES FIRST STEPS AFTER LAWNMOWER ACCIDENT

On April 24, Anna Dienstbach was at home mowing the grass.

The Dienstbachs' 4-year-old son, Caleb, was playing and Anna somehow lost track of him.

"Then I turned and he was standing right there," she said. Anna was able to swerve and disengage the blade before the mower hit her son.

"But the blade was still turning," she said. "I pulled the mower off him and grabbed him up and ran him up to the house."

The mower ran over Caleb's lower half. He suffered severe lacerations to his legs and feet. His right hand was badly cut, and his left heel was severed. His right leg was fractured in two places, and the bones in his feet and toes were crushed.

About six weeks after the accident -- with a little help from a lot of people -- he's on his feet again.

On Thursday, after undergoing several surgeries to repair the fractures, lacerations and torn muscles and ligaments, as well skin grafts for his legs and feet and a nerve graft for his right hand, Caleb walked for the first time since his accident.

Anna cried. So did Caleb, who "pitched a little fit" when it came time to get to work in his first physical therapy session, said therapist Robert Sherrill of Mid America Rehab.

Sherrill had to coax Caleb, who has casts on both legs and is now using a walker, onto his feet. It wasn't easy, but Caleb did it.

"He ended up taking a few steps and then he was happy and laughing and carrying on," Sherrill said.

Like many of Sherrill's patients, Caleb just "got a lot a little cranky" his first time out, Sherrill said.

"It's no different with the adults," he said. "I guarantee you some of them don't take it as well as he did."

Caleb says he's tired of his casts and his wheelchair. He's also pretty matter-of-fact about the injury.

"The lawn mower ran over my legs," he said. "It didn't go over my head or my stomach or I'd be dead."

"The whole time I kept thinking, oh my God, what have I done?" Anna said. She and her husband David own a lawn service company.

Caleb's doctors are pleased with his progress. "He's a trooper," said Dr. David Deisher, the plastic surgeon who performed three major reconstructive surgeries to repair Caleb's injuries.

Handling trauma cases like Caleb's all comes down to teamwork, Dr. Walker Wynkoop said, from the paramedics at the scene to the emergency department to the operating room to the intensive care unit to the outpatient care and physical therapy.

What may surprise people the most about Caleb's case is he didn't have to go St. Louis for treatment.

When Caleb came into St. Francis Medical Center the day of the accident, Wynkoop said, "the knee-jerk reaction was, off to St. Louis. It's a testament to the improvements that the medical community has made here in the last five or 10 years that we didn't have to send him off."

"When I heard what happened, my first response was that he was lucky his injuries weren't worse," said Dr. Kenneth DeCorsey, the emergency room doctor on duty at St. Francis when Caleb came in. "His vital signs were good, considering what happened. He seemed to be handling it well. The patient himself was not distressed."

Anna comes right out and admits she was "a mess."

"I was hysterical. I couldn't ride in the ambulance with him.

Deisher did the surgery to repair damaged muscles in Caleb's hand, including the nerve graft, and the skin grafts for his feet.

Two nerves to Caleb's pinky and index fingers were destroyed in the accident, Deisher said, so a nerve from the back of his leg was transplanted to "serve as a conduit to encourage renewed nerve growth."

His feet were also badly damaged, with the loss of skin, fat and soft tissue on the bottom of his left foot and the top of the right foot. A "skin flap" from Caleb's ankle and the bottom of his calf was folded down to his right foot to replace lost tissue.

For his left foot, skin grafts from Caleb's thigh were used to replace tissue lost.

The skin graft could be tricky because the heel bears so much weight, Deisher said. The transplanted skin "has to be durable enough to withstand all the wear and tear Caleb will put it through," he said.

Wynkoop handled the orthopedic surgery Caleb needed to repair torn muscles and tendons and fractures to his legs and feet. Several pins had to be inserted into Caleb's toes and feet to repair fractures to the many small bones in those areas.

Infection was also a very real concern in Caleb's case. "Every time we went in, we found grass" and other matter, Wynkoop said. Had infection set in, "Caleb could easily have lost a limb," he said.

After all the surgeries, Sherrill, as the physical therapist, gets to be the bad guy who makes Caleb put his legs and feet and hand back to work.

"He's such a cute little fellow, and you feel so much for him," Sherrill said. "You know that in the end, you have to make him better. You still have to make him work."

Right now, the biggest concern in Caleb's recovery is getting his hand back to normal. "Getting him to use the hand is the biggest thing," Sherrill said. "He keeps wanting to protect it."

There's a "very significant stiffness" in Caleb's hand because it's been so long since he used it, he said.

It's also important that Caleb get back on his feet and stay there to keep those muscles from atrophying. Wynkoop said it will probably be six months to a year, and maybe longer, before Caleb stops limping. He may need special shoes or orthopedic devices because of the injuries to his feet.

Anna is hopeful that walking won't be a problem once Caleb gets past the initial trauma of physical therapy. "He's always saying, `I want to walk on my feet. When can I walk on my feet?'"

MEDICAL TEAMWORK

Four-year-old Caleb Dienstbach under went a series of surgeries to repair lacerations and fractures caused by an April 24 lawnmower accident.

April 24: Brought by ambulance to St. Francis Medical Center after the accident, surgeons cleansed and irrigated Caleb's wounds and repaired lacerations to his legs, feet and hand.

April 26: Surgeons worked again to repair open wounds and begin installing orthopedic hardware to repair fractures to Caleb's legs and feet.

April 29: Additional orthopedic hardware was installed.

April 30: Caleb underwent skin grafts as doctors removed skin and tissue from his thigh to replace damaged tissue on his feet.