Body Wall Reconstruction for Conjoined Twins: Our Experience and Lessons Learned

Area of Science:

• Surgical reconstruction
• Congenital malformations

Background:

• Conjoined twinning is a rare congenital malformation.
• Separation of conjoined twins often results in large body wall defects, posing surgical challenges.

Observation:

• The study involved body wall reconstruction for 3 pairs of conjoined twins (2 thoraco-omphalopagus, 1 ischiopagus tetrapus) between 2004 and 2009.
• Pre-separation tissue expansion and tractive training were used to ensure adequate skin coverage.
• Post-separation reconstruction utilized synthetic materials for the thoracic cage and abdominal myofascial system, with temporary artificial skin or local flaps for wound closure.

Findings:

• One pair of thoraco-omphalopagus twins did not survive due to post-operative circulatory and respiratory failure.
• The other two pairs of conjoined twins survived, though complications included wound dehiscence, partial flap necrosis, and mesh infection requiring removal.
• Long-term complications, such as infection of synthetic mesh, can occur.

Implications:

• Effective body wall reconstruction in conjoined twin separation demands deep anatomical knowledge and advanced plastic surgery skills.
• A multidisciplinary team approach is crucial for achieving favorable surgical results in these complex cases.