Successful separation of ischiopagus tripus conjoined twins with comparative analysis of methods for abdominal wall closure and use of the tripus limb

Doski, John J.; Heiman, Howard S.; Solenberger, Robert I; Stefko, Raymond M.; Kuivila, Thomas; Rozanski, Thomas A.; Flack, Charles A; Thurman, Robert T.; Milbourn, Catherine T; Cheu, Henry W.

doi:10.1016/s0022-3468(97)90529-7

Cited by 17 publications

(10 citation statements)

References 17 publications

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“…Conjoined twins can develop a possible life-threatening condition immediately after delivery; therefore, during diagnostic and pre-separation procedures, possible emergency surgical interventions should always be considered [4][5][6][7] and emergency plans prepared. Our Institute decided to provide 24-hour duties of teams of surgeons and anaesthesiologists.…”

Section: Discussionmentioning

confidence: 99%

“…The measures applied by us to protect children did not ensure full control. The use of pre-warmed respiratory mixture proved very beneficial to maintain intraoperative normothermia [2,3,5,6].…”

Section: Discussionmentioning

confidence: 99%

“…In conjoined twins with fuse thoraxes, abdomens or heads, there is a risk of connecting the circulatory systems of both children that can be crucial during induction of general anaesthesia, particularly intravenous [5][6][7].…”

Section: Discussionmentioning

confidence: 99%

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Znieczulenie bliźniąt syjamskich — opis serii przypadków

Kobylarz

2014

Anaesthesiol Intensive Ther

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As any complex surgical procedure, separation of conjoined twins requires complex anesthesia management that is a prerequisite of performing the operation, while complex postoperative care is a decisive factor in the survival of the patients. The paper describes the anaesthetic management for surgical operations in ten sets of conjoined twins in the Children's Hospital of Cracow during 1977Cracow during -2005. The anaesthetic technique and associated problems are summarized.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Znieczulenie bliźniąt syjamskich — opis serii przypadków

Kobylarz

2014

Anaesthesiol Intensive Ther

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“…Tissue expanders implanted either subcutaneously or within the peritoneal cavity have been described, however, these are prone to infection and often require significant time before expansion prior to the definitive operation [3,4]. Other reconstructive methods include the use of syngenic cryopreserved tissue from a deceased twin [5] and use of the tripus limb in ischiopagus twins [6,7]. Traditionally polypropylene meshes have been used to bridge fascial defects, however, these too are prone to infection and hernia formation particularly in the growing child [7].…”

Section: Introductionmentioning

confidence: 99%

“…Other reconstructive methods include the use of syngenic cryopreserved tissue from a deceased twin [5] and use of the tripus limb in ischiopagus twins [6,7]. Traditionally polypropylene meshes have been used to bridge fascial defects, however, these too are prone to infection and hernia formation particularly in the growing child [7].…”

Section: Introductionmentioning

confidence: 99%

The use of Surgisis ® for abdominal wall reconstruction in the separation of omphalopagus conjoined twins

et al. 2007

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Abdominal wall reconstruction in omphalopagus twins poses a difficult reconstructive challenge, as separation often results in a large abdominal wall defect. A number of options are available for closure, including tissue flaps, expanders and patches made of foreign material. Surgisis is a new biodegradable small intestine scaffolding substrate that permits tissue in-growth and results in a permanent durable scar. We describe its use in abdominal wall reconstruction after separation of a set of conjoined twins. A set of omphalopagus conjoined twins shared liver and abdominal wall. After separation at 6 months of age, Twin A's abdomen could be closed primarily, but Twin B could not. A 4-ply Surgisis mesh was used in the upper abdominal closure, and a skin flap was created, to completely cover the patch. Both twins survived the operation. A small portion of the skin flap over the Surgisis broke down, healing by secondary intention. In follow up of over 18 months post procedure, there have been no wound infections and the abdominal wall is intact with no evidence of a hernia. Surgisis can be successfully used for the reconstruction of complex abdominal wall defects in the pediatric patient, including reconstruction after separation of conjoined twins.

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Three‐Dimensional Printed Anatomic Models Derived From Magnetic Resonance Imaging Data: Current State and Image Acquisition Recommendations for Appropriate Clinical Scenarios

Talanki

Peng

Shamir

et al. 2021

Magnetic Resonance Imaging

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Three‐dimensional (3D) printing technologies have been increasingly utilized in medicine over the past several years and can greatly facilitate surgical planning thereby improving patient outcomes. Although still much less utilized compared to computed tomography (CT), magnetic resonance imaging (MRI) is gaining traction in medical 3D printing. The purpose of this study was two‐fold: 1) to determine the prevalence in the existing literature of using MRI to create 3D printed anatomic models for surgical planning and 2) to provide image acquisition recommendations for appropriate clinical scenarios where MRI is the most suitable imaging modality. The workflow for creating 3D printed anatomic models from medical imaging data is complex and involves image segmentation of the regions of interest and conversion of that data into 3D surface meshes, which are compatible with printing technologies. CT is most commonly used to create 3D printed anatomic models due to the high image quality and relative ease of performing image segmentation from CT data. As compared to CT datasets, 3D printing using MRI data offers advantages since it provides exquisite soft tissue contrast needed for accurate organ segmentation and it does not expose patients to unnecessary ionizing radiation. MRI, however, often requires complicated imaging techniques and time‐consuming postprocessing procedures to generate high‐resolution 3D anatomic models needed for 3D printing. Despite these challenges, 3D modeling and printing from MRI data holds great clinical promises thanks to emerging innovations in both advanced MRI imaging and postprocessing techniques. Evidence Level 2 Technical Efficatcy 5

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Successful separation of ischiopagus tripus conjoined twins with comparative analysis of methods for abdominal wall closure and use of the tripus limb

Cited by 17 publications

References 17 publications

Znieczulenie bliźniąt syjamskich — opis serii przypadków

Znieczulenie bliźniąt syjamskich — opis serii przypadków

The use of Surgisis ® for abdominal wall reconstruction in the separation of omphalopagus conjoined twins

Three‐Dimensional Printed Anatomic Models Derived From Magnetic Resonance Imaging Data: Current State and Image Acquisition Recommendations for Appropriate Clinical Scenarios

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