Intra-abdominal tissue expansion: an adjunct in the separation of conjoined twins

Intra-abdominal tissue expansion routinely occurs physiologically with pregnancy and may be seen in a variety of pathologic states. There are a number of situations where additional abdominal wall would be helpful. We encountered such a situation in a set of ischiopagus conjoined twins. In effect, separation would result in an abdominal wall deficit of approximately 50%. As an alternative to intraperitoneal air, we inserted two 1,000 mL tissue expanders through a subcostal incision at 6 months of age. Over the ensuing 7 weeks, each expander was gradually inflated to greater than capacity (1,250 mL each). Except for initial ileus, there was no difficulty in expanding the abdomen to enormous proportions. At the time of surgical separation, the expanders were removed and the available abdominal wall tissue almost closed directly on both children. Closure was complete in one baby, whereas a small upper abdominal wall defect was left in the other, necessitating Marlex reinforcement. There has been a recent explosion in the use of tissue expanders in reconstructive surgery. From head to toe, soft tissue can be expanded to be used as flaps, to close donor defects, or both. With this report, its use intra-abdominally is described. Future application is limited only by our ingenuity and imagination.