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CC BY-NC-ND 4.0 · Indian J Plast Surg 2022; 55(01): 036-044
DOI: 10.1055/s-0041-1740406
Original Article

First Successful Separation of Craniopagus Twins in India—Plastic Surgical Considerations

Maneesh Singhal
1   Department of Plastic Reconstructive and Burns Surgery, Burns & Plastic Surgery Block, All India Institute of Medical Sciences New Delhi, India
,
Shanmuganathan Raja Sabapathy
2   Division of Plastic, Hand, Reconstructive Microsurgery and Burns, Ganga Hospital, Coimbatore, Tamil Nadu, India
,
Deepak Gupta 
3   All India Institute of Medical Sciences, New Delhi, India
,
A. K. Mahapatra
4   SOA University, Odisha, India
,
Shashank Chauhan 
1   Department of Plastic Reconstructive and Burns Surgery, Burns & Plastic Surgery Block, All India Institute of Medical Sciences New Delhi, India
,
Raja Tiwari 
1   Department of Plastic Reconstructive and Burns Surgery, Burns & Plastic Surgery Block, All India Institute of Medical Sciences New Delhi, India
,
Hari Venkatramani
2   Division of Plastic, Hand, Reconstructive Microsurgery and Burns, Ganga Hospital, Coimbatore, Tamil Nadu, India
,
Shweta Kedia
3   All India Institute of Medical Sciences, New Delhi, India
,
Shivangi Saha 
1   Department of Plastic Reconstructive and Burns Surgery, Burns & Plastic Surgery Block, All India Institute of Medical Sciences New Delhi, India
,
Shamendra Anand Anand Sahu 
5   Department of Plastic Surgery, All India Institute of Medical Sciences Raipur, Chhattisgarh, India
,
Suvashis Dash 
1   Department of Plastic Reconstructive and Burns Surgery, Burns & Plastic Surgery Block, All India Institute of Medical Sciences New Delhi, India
,
Megha Sodhi 
1   Department of Plastic Reconstructive and Burns Surgery, Burns & Plastic Surgery Block, All India Institute of Medical Sciences New Delhi, India
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Abstract

Separation of total vertical craniopagus with shared venous sinuses poses multiple challenges. Provision of soft-tissue cover to the exposed brains at the time of total separation is one of them, due to the large size of the defect and paucity of local tissues. Staged separation of twins is advised with partial venous and parenchymal disconnection in the first stage and total separation in the second stage. Tissue expanders are inserted in the first stage, and second stage planned to coincide with the period of adequate expansion. In the child being reported, emergency second stage was done due to the deteriorating general condition of the children. Left with inadequate expanded skin, the critical defect in a twin was managed with bilateral trapezius myocutaneous flaps. High ionotropic support of the postoperative period resulted in superficial necrosis of the flap, which was managed by debridement, allograft application and autograft later. Both twins had well-healed wounds by 3 months.

Keywords

Craniopagus separation - tissue expander - conjoint twins - trapezius myocutaneous flaps - dermal matrices - allograft

Details of Earlier Presentation

The paper was presented in APSICON 2018, Lucknow, UP, India.


Declaration

Authors declare that consent for publication with identifiable photographs was obtained from the parents.




Publikationsverlauf

Artikel online veröffentlicht:
25. Februar 2022

© 2022. Association of Plastic Surgeons of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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