The role of rapid tissue expansion in separating xipho-omphalopagus conjoined twins in Vietnam

Abstract

Conjoined twins are rare, and each set of conjoined twins has a unique conjoined anatomy. It is necessary to perform separation to increase the chance of patient survival. Tissue expansion is an advanced technique for providing sufficient soft tissue and skin for wound closure. We report the successful application of rapid tissue expansion in 10-month-old xipho-omphalopagus conjoined twins in Vietnam. A tissue expander was placed on the anterior body between the sternum and umbilicus with a baseline of 70 mL sterile saline (0.9% NaCl). The first injection into the tissue expander began on the 6th day after expander insertion, and injections continued every 2 days with approximately 30–70 mL per injection according to the expansion of the skin. The expander reached 335 mL after six injections and within 10 days. In order to prepare for surgical separation, expansion was completed on the 15th day after insertion. The expanded skin area was estimated to be 180 cm2, which was sufficient to cover both patients’ skin deficiencies. The twins presented for surgical separation 6 days following the completion of tissue expansion. Both babies were discharged in good health 1 month after separation.

Serial Tissue Expansion and Skin Grafts in the Management of a Giant Congenital Nevus of the Face: Review of Literature and Case Report

“…This suturing technique has been successfully applied to our patients indicated for reconstruction with a tissue expander. 22 …”

“…In addition, during the first two weeks after expander placement, we try to inject as often as possible, approximately four times a week, because the absence of a capsule makes the skin less resistant to expansion. This suturing technique has been successfully applied to our patients indicated for reconstruction with a tissue expander [22].…”

Lower Extremity Pediatric Tissue Expansion

“…[1][2][3][4] Performing expansion adjacent to a defect allows for the growth of new skin as a continuation of the same tissue type, as well as the preservation of its neurovascular supply. 5 As such, local tissue expansion is routinely performed to address soft-tissue defects in children, including regions such as the lower limb, buttocks, and perineum [4][5][6][7][8] and has thus become the standard of care for the reconstruction of trauma-or burn-related scarring, giant congenital melanocytic nevi, and hemangiomas. 4,5,7,8 Despite the broad applications of tissue expanders in the pediatric population, reported complication rates in current literature range from 19% to 40%, with notable variability across indications, age groups, and anatomic regions.…”

“…Reconstruction of soft tissue defects in childhood enables earlier aesthetic and functional improvement. 7,17 Among children, the lower extremity is the site of 38% of giant congenital melanocytic nevi, 57% of burn injuries, and roughly two thirds of hemangiomas. [18][19][20] Unfortunately, the geometry of the lower extremity and poor skin flexibility limits the use of regional expansion, particularly in the case of large defects.…”

“…Reconstruction of soft tissue defects in childhood enables earlier aesthetic and functional improvement 7,17 . Among children, the lower extremity is the site of 38% of giant congenital melanocytic nevi, 57% of burn injuries, and roughly two thirds of hemangiomas 18–20 .…”