The role of rapid tissue expansion in separating xipho-omphalopagus conjoined twins in Vietnam

Conjoined twins are rare, and each set of conjoined twins has a unique conjoined anatomy. It is necessary to perform separation to increase the chance of patient survival. Tissue expansion is an advanced technique for providing sufficient soft tissue and skin for wound closure. We report the successful application of rapid tissue expansion in 10-month-old xipho-omphalopagus conjoined twins in Vietnam. A tissue expander was placed on the anterior body between the sternum and umbilicus with a baseline of 70 mL sterile saline (0.9% NaCl). The first injection into the tissue expander began on the 6th day after expander insertion, and injections continued every 2 days with approximately 30–70 mL per injection according to the expansion of the skin. The expander reached 335 mL after six injections and within 10 days. In order to prepare for surgical separation, expansion was completed on the 15th day after insertion. The expanded skin area was estimated to be 180 cm², which was sufficient to cover both patients’ skin deficiencies. The twins presented for surgical separation 6 days following the completion of tissue expansion. Both babies were discharged in good health 1 month after separation.

Keywords

Xipho-omphalopagus conjoined twins - Conjoined twins - Tissue expansion - Separation - Vietnam

Publication History

Received: 12 December 2020

Accepted: 12 April 2021

Article published online:
21 March 2022

• REFERENCES

• 1 Mutchinick OM, Luna-Munoz L, Amar E. et al. Conjoined twins: a worldwide collaborative epidemiological study of the International Clearinghouse for Birth Defects Surveillance and Research. Am J Med Genet C Semin Med Genet 2011; 157C: 274-87
• 2 Spitz L, Kiely EM. Experience in the management of conjoined twins. Br J Surg 2002; 89: 1188-92
• 3 Spencer R. Anatomic description of conjoined twins: a plea for standardized terminology. J Pediatr Surg 1996; 31: 941-04
• 4 Trost Jr JG, Lin LO, Clark SJ. et al. Separation of thoracoomphalo-ischiopagus conjoined twins: surgical planning, management, and outcomes. Plast Reconstr Surg 2016; 138: 1064-72
• 5 Jackson OA, Low DW, LaRossa D. Conjoined twin separation: lessons learned. Plast Reconstr Surg 2012; 129: 956-63
• 6 Zubowicz VN, Ricketts R. Use of skin expansion in separation of conjoined twins. Ann Plast Surg 1988; 20: 272-6
• 7 Clifton MS, Heiss KF, Keating JJ. et al. Use of tissue expanders in the repair of complex abdominal wall defects. J Pediatr Surg 2011; 46: 372-7
• 8 Spitz L, Capps SN, Kiely EM. Xiphoomphaloischiopagus tripus conjoined twins: successful separation following abdominal wall expansion. J Pediatr Surg 1991; 26: 26-9
• 9 Fallon SC, Olutoye OO. The surgical principles of conjoined twin separation. Semin Perinatol 2018; 42: 386-92
• 10 Spitz L, Stringer MD, Kiely EM. et al. Separation of brachiothoraco-omphalo-ischiopagus bipus conjoined twins. J Pediatr Surg 1994; 29: 477-81
• 11 Ali KA. Management of conjoined twins during neonatal period. Ann Pediatr Surg 2010; 6: 105-10
• 12 Hilfiker ML, Hart M, Holmes R. et al. Expansion and division of conjoined twins. J Pediatr Surg 1998; 33: 768-70
• 13 Foglia R, Kane A, Becker D. et al. Management of giant omphalocele with rapid creation of abdominal domain. J Pediatr Surg 2006; 41: 704-9
• 14 Radovan C. Tissue expansion in soft-tissue reconstruction. Plast Reconstr Surg 1984; 74: 482-92
• 15 Wagh MS, Dixit V. Tissue expansion: concepts, techniques and unfavourable results. Indian J Plast Surg 2013; 46: 333-48
• 16 Braun TL, Hamilton KL, Monson LA. et al. Tissue expansion in children. Semin Plast Surg 2016; 30: 155-61
• 17 Liu YJ, Hultman CS. The theory and practical use of the Z-incision for the relief of scar contractures. In: 50 Studies every plastic surgeon should know. Boca Raton: CRC Press; 2014: 9
• 18 Argenta LC. Controlled tissue expansion in reconstructive surgery. Br J Plast Surg 1984; 37: 520-09
• 19 Bauer BS, Margulis A. The expanded transposition flap: shifting paradigms based on experience gained from two decades of pediatric tissue expansion. Plast Reconstr Surg 2004; 114: 98-106