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Conjoined twins successfully separated with expanded tissue closure

Plastic surgery services joined a surgical team to successfully separate thoraco-omphalo-ischiopagus tetrapus conjoined twins, according to a case report published in Plastic and Reconstructive Surgery.

It was determined that the twins, both female, would require reconstruction of the thoracic and abdominal cavities, as well as guided wound closure. The multidisciplinary surgical team began preparation by using 3-D models created from CT imaging to estimate the postseparation soft-tissue deficit.

Two custom-designed subcutaneous tissue expanders were positioned along the umbilical and posterior thoracoabdominal walls. A third expander had been ordered to account for possible issues. It was used after a puncture to one of the implants that occurred while accessing the internal port.

The twins were aged 10 months at the time of operation. Reconstructive teams were allocated to each twin, which included members from urology, pediatric gynecology and orthopedic surgery, along with the plastic surgeons. After reconstruction, congenital heart surgery and plastic surgery completed closure of the thorax and abdomen.

Minor complications, such as tissue edema and a protruding heart in one of the twins, led to the use of acellular dermal matrix to cover the abdominal organs before primary closure.

“Extensive preoperative planning may still result in the need for additional grafts, flaps or delayed wound closure,” the researchers wrote. “Intraoperative edema proved the largest obstacle against immediate closure. Nonetheless, the use of negative-pressure wound therapy allowed for rapid relief of tissue edema and a safer, delayed closure through flap advancement.”

One twin was discharged in good health at 11 weeks after separation while the other was discharged at 17 weeks with a home ventilator after treatment for multiple pneumonias. – by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures.