Surgeons perform skin expansion procedure on conjoined twins at UCLA's Mattel Children's Hospital

Doctors at UCLA's Mattel Children's Hospital will perform a skin expansion procedure June 24 on Maria Teresa and Maria de Jesus Quiej-Alvarez, 11-month-old twins joined at the skull. UCLA plastic surgeons will implant balloons under the babies' scalps to gently stretch the skin enough to protect their brains after their separation surgery in mid-July.

"Stretching the scalp will enable us to create two skin flaps large enough to cover both babies' heads after their final separation," explained UCLA plastic and reconstructive surgeon Dr. Henry Kawamoto Jr.

According to Kawamoto, surgical director of the UCLA Craniofacial Clinic, the issue transcends the aesthetic. In previous cases, twins joined at the heads have died when infection entered the incision after separation. Because the babies' brains adjoin each other, enough scalp currently exists to cover only one of their heads.

The procedure itself is fairly routine. After shaving the twins' hair, UCLA plastic surgeons will make a tiny incision on one side of the babies' heads, between their ears. In the small groove separating the twins' heads, Kawamoto will thread two eight-inch long silicone balloons around the girls' heads, creating a bulging, halo effect under their scalps.

The end of the balloon runs into a slender hose with a self-sealing valve. Twice a day, doctors will inject saline solution into the valve. The entire process should last two to three weeks.

"The saline swells the balloon to expand the tissue above it," Kawamoto said. "The expander operates in a similar fashion to how the fetus stretches its mother's abdominal skin during pregnancy."

Tissue expansion enables the body to "grow" extra skin for use in reconstructing almost any part of the body. The procedure is most commonly used in breast reconstruction when not enough skin exists to accommodate a permanent implant after mastectomy. Surgeons prefer to use tissue expansion to reconstruct part

Contact: Roxanne Moster
University of California - Los Angeles

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