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Anterior Chest Wall Reconstruction After Separation of Thoraco-Omphalopagus Conjoined Twins With Cadaveric Rib Grafts
Ammar S A Hashemi, Alejandro Gimenez1, Nicholas Yim
1From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine.
Insights
This study successfully reconstructed anterior chest wall defects in conjoined twins using cadaveric ribs and omental flaps. Both patients achieved stable reconstructions, with one twin no longer requiring respiratory support after healing.
Area of Science:
- Pediatric Surgery
- Thoracic Reconstruction
- Congenital Abnormalities
Background:
- Anterior chest wall defects in children stem from diverse causes like infection, tumors, trauma, and congenital conditions.
- Reconstruction aims to stabilize the chest, eliminate dead space, maintain cardiopulmonary function, and protect mediastinal organs.
- Choosing reconstruction methods for the pediatric population presents challenges due to skeletal growth.
Background:
Anterior chest wall defects have a wide range of etiologies in the pediatric population, ranging from infection, tumor, and trauma to congenital diseases. The reconstructive goals include restoring skeletal stability, obliterating dead space, preserving cardiopulmonary mechanics, and protecting vital underlying mediastinal organs. Although various reconstructive methods have been described in the literature, selecting the optimal method is challenging for the growing pediatric skeleton. Here, we report a case of previously thoraco-omphalopagus twins who underwent successful separation and reconstruction and presented for definitive anterior chest wall reconstruction.
Methods:
A pair of previously thoraco-omphalopagus conjoined twins underwent definitive anterior chest wall defect reconstruction using cadaveric ribs and omental flap. Twin A received 2 cadaveric ribs, whereas twin B had a much larger sternal defect that required 3 cadaveric ribs combined with an omental flap for soft tissue chest coverage. Both twins were followed up for 8 months.
Results:
Twin A's postoperative course was uneventful, and she was discharged on postoperative day 6. Twin B's course was complicated, and she was discharged on supported ventilation on postoperative day 10. At 8 months postoperatively, both twins healed well, and chest radiographs confirmed the stability of the chest reconstructions. The rib grafts in the twin with a tracheostomy were not mobile, and the patient had a solid sternum with adequate pulmonary expansion. The construct initially did not facilitate pulmonary functioning, but after a healing process, it eventually allowed for the twin with the tracheostomy who required pulmonary assistance to no longer need this device.
Conclusions:
Cryopreserved cadaveric ribs and omental flaps offer safe and reliable reconstructive methods to successfully reconstruct congenital anterior chest wall skeletal defects in the growing pediatric population. The involvement of multidisciplinary team care is key to optimizing the outcomes.
