Woman Goes Under the Knife

Curious doctors and journalists gathered Tuesday morning to watch lengthy and challenging "face-off" surgery performed on a disfigured Surabayan woman. The surgery, screened live on monitors at Dr. Soetomo Hospital in the East Java capital, was performed on Siti Nur Jazilah, who was scarred in an acid attack three years ago.

The complicated operation, conducted by a 25-strong team of doctors led by Sjaifuddin Noer, a
surgeon, was divided into several stages estimated to take a total of 17 hours. Siti's entire facial skin was removed and replaced with skin taken from her back, using a free-flap system that was the first to be performed in the country. Her back skin would be replaced with skin grafts taken from her thigh.

"We hope everything runs smoothly as planned," the hospital's deputy director, Teguh Sylvaranto,
said before the surgery. Costs of the surgery, earlier estimated at Rp 20 million (US$2,173) and covered by the hospital, were estimated to jump to hundreds of millions. Medication alone has cost Rp 54 million.

If successful, it will provide a new start for the 19-year-old, who spends most of her time shut
away in her home in Sidoarjo regency, East Java. "The surgery is expensive but don't let the costs get in the way of the surgery. The most important thing is that the team of doctors is doing its best," said hospital director Slamet Riyadi Yuwono.

Doctors Guard Against Infection

The team of doctors at the Dr. Soetomo Hospital in Surabaya, who successfully performed landmark facial surgery on a woman Tuesday, are concerned of the possibility of infection in the healing of grafted skin. The woman was undergoing surgery as her face was badly disfigured after being doused with acid.

"And should that happen, there is the likelihood that her condition would deteriorate drastically which could eventually lead to death," said a member of the team, Dr. David Sontani Perdanakusuma, after a post-surgery evaluation meeting in Surabaya on Thursday.

According to him, doctors are ensuring that the isolation room at the Intensive Care Unit of the hospital's Central Integrated Surgical facility -- where the patient, Siti Nur Jazilah, or Lisa, is recuperating -- remains completely sterile.

"We are worried, especially about the risk of infection, so that's why we are limiting access to the room, including to the doctors," said David. A team of microbiologists, led by Dr. Kuntaman, is carrying out bacterial culturing on Lisa's face. Infection is usually detected on the fourth or fifth day after surgery, or early next week in this case.

The surgery, using the free-flap system, performed at the hospital on March 28 was successful, despite it taking an hour longer than the estimated 17 hours. The delay was due to the delicate process of connecting blood vessels (the most difficult stage of the surgery), as well as complications encountered during the forming of lips and eyelids, after the skin taken from her back was implanted on her face which needed 80 stitches.

Lisa finally regained consciousness at 5 a.m. Wednesday. However, the 22-year-old woman has not passed the critical period yet. Lisa was visited Friday by her father Saring, grandfather Samsuri and grandmother Wagina and a number of other family members. They could not have direct contact with Lisa, but were able to see her through a CCTV monitor accompanied by several members of her medical team.

Meanwhile, evaluation results two days after the surgery disclosed that the implanted skin on Lisa's face had shown signs of "developing", as seen from the blood permeating the right and left temples, where the blood vessels were attached. "This shows that we have attached the blood vessels successfully," said vice director of Dr. Soetomo Hospital, Teguh Sylvaranto.

Lisa is still receiving blood transfusions. She has so far received 18 units of blood. "The blood flowing throughout her body now is totally donors' blood," said Teguh. This has, however, raised concern of the presence of a blood clot.

From the CCTV installed in the evaluation room, Lisa was noticed still asleep on a Clinitron Bed (an antigravity bed made of silica sand), with a 40-watt lamp focused on her face, which was covered with bandages, to provide warmth and facilitate blood flow, and a tracheotomy tube placed in her throat.

Lisa is expected to receive treatment for two weeks, followed by outpatient treatment thereafter. Doctors will construct facial textures when her wounds have healed, such as eyebrow and eyelashes. "We will do this as time goes on," said Dr. David, who is also a plastic surgeon.***