Abstract
Background Composite tissue allotransplants are performed for various defects when local, or
distant reconstructive options are limited. Though this type of transplant replaces
similar tissue, it is complicated by immunosuppression. This limitation may be avoided
in monozygotic twins since they share identical genetic code. Free soft tissue transplantation
across identical twins has been reported for breast, scalp, and thoracic reconstruction
when autologous tissues were insufficient. We present a case of a successful deep
inferior epigastric artery perforator (DIEP) flap transplantation in monozygotic twins.
Methods The recipient twin was a patient with history of breast cancer and failed prosthetic
reconstruction. She desired autologous reconstruction with a DIEP flap but had insufficient
donor tissue. She refused alternative sites; however, she had an identical twin willing
to donate her excess abdominal tissue. The twins underwent deoxyribonucleic acid testing,
human leukocyte antigen/blood type testing, and screening for communicable diseases.
Results The twins were found to have greater than 99.99% probability of being monozygotic
twins. A bipedicled conjoined DIEP was harvested from donor twin and transplanted
to recipient twin. Immunosuppressive regimen was not utilized. Patients healed uneventfully
and are currently 5 years postop without long-term complications.
Conclusion Isogeneic flap transplant is a viable option to consider when autologous tissues
are restricted, and monozygotic twins are present. Appropriate counseling of twins
is critical for a successful and satisfactory outcome.
Keywords
twin transplantation - soft tissue transplantation - breast reconstruction - flap
transplantation - DIEP transplantation
