title: Conjoined twin separation:  lessons learned.
abstract: BACKGROUND
  The separation of conjoined twins presents a unique challenge to many pediatric surgical specialties. A multidisciplinary approach is essential for successful twin separation, and plastic surgeons are critical members of this surgical team when soft-tissue requirements preclude simple closure.
  
  
  METHODS
  In this article, the authors review multiple techniques available to plastic surgeons for providing adequate soft-tissue coverage in this unique clinical situation and present lessons learned from their experience at The Children's Hospital of Philadelphia with seven conjoined twin separations performed between the years 1980 and 2007.
  
  
  RESULTS
  Successful separation was accomplished in six of the seven conjoined twin pairs, expander complications requiring reoperation occurred in three twin pairs, and skin grafting was required because of insufficient expansion in two twin pairs. The techniques found to be critical to successful separation include maximal extracavitary tissue expansion with smooth-wall remote port tissue expanders, protection of expanded skin through pressure-reducing strategies, fluorescein vascular territory mapping, the use of frozen banked autogenous skin for salvage, and the use of supplemental nutritional support.
  
  
  CONCLUSIONS
  The overall success of conjoined twin separation depends on the experience and preparedness of the treating team and the resources available at the pediatric specialty center. Multiple techniques are available to plastic surgeons to optimize success in this challenging clinical situation.
  
  
  METHODS
  Therapeutic, V.
authors.affiliation: Philadelphia, Pa. From the Division of Plastic Surgery, The Children's Hospital of Philadelphia and the University of Pennsylvania.
authors.forename: Oksana A
authors.initials: OA
authors.lastname: Jackson
authors.forename: David W
authors.initials: DW
authors.lastname: Low
authors.forename: Don
authors.initials: D
authors.lastname: LaRossa
mesh_terms: D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012086:Reoperation; D016038:Skin Transplantation; D013524:Surgical Flaps; D015626:Tissue Expansion; D014428:Twins, Conjoined / Q000145:classification / Q000473:pathology / Q000601:surgery*