Singhal Maneesh, Sabapathy Shanmuganathan Raja, Gupta Deepak, Mahapatra A K, Chauhan Shashank, Tiwari Raja, Venkatramani Hari, Kedia Shweta, Saha Shivangi, Sahu Shamendra Anand Anand, Dash Suvashis, Sodhi Megha
Department of Plastic Reconstructive and Burns Surgery, Burns & Plastic Surgery Block, All India Institute of Medical Sciences New Delhi, India.
Division of Plastic, Hand, Reconstructive Microsurgery and Burns, Ganga Hospital, Coimbatore, Tamil Nadu, India.
Indian J Plast Surg. 2022 Feb 25;55(1):36-44. doi: 10.1055/s-0041-1740406. eCollection 2022 Feb.
Separation of total vertical craniopagus with shared venous sinuses poses multiple challenges. Provision of soft-tissue cover to the exposed brains at the time of total separation is one of them, due to the large size of the defect and paucity of local tissues. Staged separation of twins is advised with partial venous and parenchymal disconnection in the first stage and total separation in the second stage. Tissue expanders are inserted in the first stage, and second stage planned to coincide with the period of adequate expansion. In the child being reported, emergency second stage was done due to the deteriorating general condition of the children. Left with inadequate expanded skin, the critical defect in a twin was managed with bilateral trapezius myocutaneous flaps. High ionotropic support of the postoperative period resulted in superficial necrosis of the flap, which was managed by debridement, allograft application and autograft later. Both twins had well-healed wounds by 3 months.
分离共用静脉窦的完全垂直颅联体带来了多重挑战。完全分离时为暴露的大脑提供软组织覆盖就是其中之一，因为缺损面积大且局部组织匮乏。建议对连体双胞胎进行分期分离，第一期进行部分静脉和实质离断，第二期进行完全分离。在第一期插入组织扩张器，计划第二期与充分扩张期相吻合。在本报告的患儿中，由于患儿总体状况恶化，进行了急诊第二期手术。由于扩张后的皮肤不足，其中一个连体婴儿的关键缺损采用双侧斜方肌肌皮瓣进行处理。术后高剂量的离子otropic支持导致皮瓣表面坏死，通过清创、应用同种异体移植物和后期自体移植进行处理。3个月时，两个连体婴儿的伤口均愈合良好。 （注：原文中“High ionotropic support”里“ionotropic”可能有误，推测可能是“inotropic”，“高剂量的变力支持” ，这里按原文翻译）
