Warning: This story has photos some may find disturbing.
Surgeon Simon Chong, discussing the treatment to help reduce the size of Lautaimi Faumuina's leg. Photo: RNZ / Marika Khabazi
A man whose leg swelled so large he could not lift it to walk now has his mobility back after successful surgery.
When surgeon Simon Chong first saw American Samoan man Lautaimi Faumuina, his right leg had become so enlarged it was the size of a torso, encased in folds of fat.
The skin folds had become hard and calloused, overlapping his foot until only the ends of his toes peeked out - now he can see his toes again.
"It's so clear to see my toes," Faumuina said.
"Hopefully I can accomplish some things that were hard for me to do before the operation."
Faumuina developed lymphoedema from a parasitic infection over a decade ago, a common cause of the condition in the tropics.
Lautaimi's leg before he started treatment in New Zealand. Photo: Supplied
Over years, his leg swelled bigger because part of his lymphatic system was blocked, causing a build-up of fluid and fat - it's why he stopped working in 2012 when he was in his early 40s.
The 55-year-old is in New Zealand on a medical visa from American Samoa, and had the life-changing surgery for free last week, giving him back his mobility and the prospect of once again wearing shoes.
Surgeon Simon Chong has set up the first private practice in New Zealand to treat lymphoedema, and did the operation pro bono last week.
He took out half a kilogram of skin, fibrous tissue and fluid from Faumuina's foot during the operation, which he said went well.
"His leg is still shrinking, and now with all that extra tissue off his foot, I'm hopeful that this will continue to drive more swelling out of the foot," Chong said.
"I expect in the coming year or so his foot will continue to decrease in size."
Chong said Faumuina could not lift his leg to walk when he first saw him, and the swelling was the worst he has seen.
He said watching Faumuina walk into his office after surgery was a memorable moment.
"That's a dramatic difference to when I first met him, when he was dragging the leg on the ground behind him, and he had to use a rope to help lift his leg into bed at night," Chong said.
"This is this is huge for him. He's got his mobility back and he no longer has such a heavy weight at the end of his leg to drag around."
Surgeon Simon Chong says surgical treatment for lymphoedema should be available for New Zealanders, and has set up a private clinic, the first to offer it here. Photo: Supplied
In New Zealand, the condition is commonly the result of having lymph nodes removed in cancer treatment.
A plastic and reconstructive surgeon, Chong said advances in medicine meant if lymphoedema was treated early, people need not suffer swollen limbs.
"It is part of the cancer journey that doesn't necessarily end, even when you have beaten the cancer you always have this reminder of what has happened and you never fully return to normal," Chong said.
"It's a life sentence that you carry with you, and we think that's completely unnecessary."
Chong said the New Zealand health system was simply managing the condition and that needed to change.
He has travelled overseas to train in microsurgery that re-routes the lymphatic system, using thread as thin as hair, with specialists in Sweden and Japan.
It's the type of treatment that can prevent lymphoedema advancing, but until now patients have had to travel abroad.
The Australian Lymphoedema Education, Research and Treatment Programme confirmed nine New Zealand patients had travelled to its Melbourne hospital for treatment since January last year, five of whom had microscopic surgery to re-route part of their lymphatic system.
Chong is a member of the Australiasian Lymphology Association and has set up a private practice in Auckland with specialist equipment to treat the condition, within the Auckland Plastic Surgery Group in Highbrook.
"This is something that we can do for New Zealanders, this is something that we can bring to New Zealand, educate people, educate the doctors, educate the patient and lift the standard of care to where we think it should be in this day and age."
Chong said he realised early on that he would need to start this in private practice, due to the challenges facing the public healthcare system.
But he said his vision is that surgical treatment for lymphoedema will one day be available through the public health system.
"I do genuinely believe that those challenges will one day be met and so what we need to do in the meantime is do what we can to build up, so ultimately we can pivot the service that we create into the public space, so that all New Zealanders can access it.
Chong said his hope is that lymphoedema in New Zealand is a thing of the past because it will be prevented.
"We are just at the start of building a service, but we want this eventually to be accessible to New Zealanders nation-wide, and we do eventually want the skillsets and the operations and the care to permeate and become a part of the New Zealand public health system."
He said his aim is to get lymphoedema surgery covered by medical insurers.
"The feedback we've gotten so far is that the clinical rationale for support care has been recognised and where we're running into barriers, it's not because they are unconvinced about the efficacy of the surgery and what it can do for people. That's not the issue. The issue is financial and costs.
Chong said Faumuina us due to return to American Samoa in January, where lymphoedema therapist Diane Lacey has helped to set up ongoing support to help reduce the swelling.
He said Faumuina's story had helped to raise awareness of the condition.
"It's a really rewarding thing to be able to do something for someone, and for it to have meaning in their lives. It sounds kind of cliche to say that, but you do genuinely feel it in your heart when you see such a big difference in such short time."
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