Christine Brown's facial surgery complicated by Dunedin water contamination
A 16-hour face reconstruction on a Southland woman at Dunedin Hospital was complicated by tap water to the operating theatre becoming contaminated.
Untreated water entered Dunedin's public water supply, with the issue coming to a head for the hospital halfway through a long and complex operation on Christine Brown's face on Tuesday.
"It meant water to the hospital became unusable halfway through the operation," surgeon Matthew Leaper said.
"It was a bit of a challenge."
Tap water is used in surgeries for the clinicians to "scrub up" and to sterilise instruments.
The surgeons operating on Brown improvised, and instead used bottled water and a chemical and disinfectant for hand washing.
Other routine surgeries scheduled at the hospital were cancelled due to the water contamination, he said.
It was one of many issues the clinical team dealt with during one of the most challenging surgeries of Leaper's career.
He was pleased with the final outcome, but obstacles had to be overcome during Brown's marathon face surgery.
"Everything was a bit tricky the whole way through," Leaper said.
"Her skin tissue wasn't normal, there was scarring from previous surgeries and she's missing an artery to the right side of her cheek.
"The anatomy wasn't as one would expect."
The first 90 minutes of the operation were taken up by anaesthetists putting "lines" into Brown.
The surgeons then lifted the right side of Brown's face, and at 1pm they made the decision to go ahead with removing bone from her fibula, in her leg, to make her a cheek bone.
"When we decided she had vessels in her neck, it meant we could connect the bone from her leg [to her face]," Leaper said.
"You need something to connect to."
They cut an 11-centimetre bone from her leg and used it to rebuild the right side of her face.
The majority of the bone was used as a cheek bone, but some was also used to recontour her eye socket so her lower eyelid could be reattached.
The surgeons attached the cheekbone into her face using screws and plates, and connected it to the vessel in her neck.
"It took hold, it's quite neat how it works . . . it's still got blood flowing," Leaper said.
The cheek bone has given her face structure and support.
"We also took some fat from her tummy to fill a defect in her temple," he said.
Other work included widening and shortening Brown's ear canal and lifting her ear to the correct level on her head.
The surgery was reasonably difficult because of scarring on her face from multiple previous surgeries, Leaper said.
"Her skin was very stretched from the side of her face being so sagged down.
"There were a lot of growths on her face, so the tissue was quite abnormal and the skin had thinned because it had stretched over time.
"The skin on the side of her face was quite abnormal."
Three surgeons and two surgical registrars did the operation, while anaesthetists and nurses were also involved.
The surgeons had taken turns, he said.
"It's all gone well, it's really pleasing.
"She's recovering well and everything is going to plan, which is nice . . . things are significantly improved."
It was too early to say if more operations would be needed, though it was possible she would need a "little tidy up".
The surgeons had "built up" the right side of Brown's face, which had sunken in.
"It will be swollen for a little while, we will see how it settles down," he said.
"But this operation has been the main event, lifting everything back up, and it's gone really well."
He was optimistic the side of her face would stay up long term.
"It all looks quite stable. It's a long road ahead but I am optimistic.
"She's looking good, actually. It's surprising when you see the difference, golly, it's nice."
Brown was born with neurofibromatosis, which causes multiple tumours to grow on nerves in her body, including her face.
When aged 7, a massive tumour dragging her face down was operated on for the first time, and she had undergone multiple operations over the years.
She has now endured 18 surgeries on her face.
The first 17 had been unsuccessful in aligning her face, but Brown's husband, Lee, speaking from her hospital bedside on Friday, said the 18th operation on Tuesday had the best outcome of them all.
"They said from the outset what they were going to do and what they wanted to achieve and that it might fail. But it didn't.
"They are brilliant. What they have done is absolutely miraculous."
His wife, recovering in Dunedin Hospital, was sedated and in no condition to chat to Stuff on Friday.
She had still not seen herself in the mirror after the operation.
- The Southland Times