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UCLA surgeons complete skin expansion procedure on conjoined twins

Doctors at UCLA's Mattel Children's Hospital completed a skin expansion procedure at 3:30 p.m. on June 24 on Maria Teresa and Maria de Jesus Quiej-Alvarez, 11-month-old twins joined at the skull. UCLA plastic surgeons implanted balloons under the babies' scalps to stretch the skin enough to cover their heads after their separation surgery next month.

"This was almost a dress rehearsal for the twins' longer surgeries next month," explained UCLA plastic and reconstructive surgeon Dr. Henry Kawamoto Jr., who conducted the 75-minute skin expansion procedure. "The time was well spent discussing what we'll need to do next time and the type of supplies we'll require in the operating room."

Both twins responded well to the anesthesia and surgery. Surgeons encountered a minor problem, however, when inserting one of the four expander balloons.

"The skin in one spot was very thin, and the scalp tore slightly in the groove between their heads," said Kawamoto. "We stitched the wound together, but we will not be able to expand the scalp there until the skin heals."

Surgeons inflated the three remaining balloons with saline solution. Still, UCLA will postpone the separation surgery until the torn tissue heals and is able to be stretched. Doctors do not know how long the delay will be. Because the twins will remain in the hospital, however, Kawamoto will be able to monitor the babies on a daily basis.

Prepping the babies for surgery lasted two hours. After anesthesia, the doctors faced the dilemma of how to best position the twins to gain access to their heads for surgery. After much discussion, the doctors rested one twin on her back, facing up, and the other twin on her abdomen, her face cradled in an open cushion shaped like a donut.

After shaving the infants' hair, the doctors used an ultrasound wand on the girls' heads to detect major blood vessels. These were inked in red on their scalp so surgeons would know where to avoi
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Contact: Roxanne Moster
roxannem@support.ucla.edu
310-794-0777
University of California - Los Angeles
24-Jun-2002


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