TY - JOUR
T1 - Use of local perforator flaps for closure of a thoraco-omphalopagus conjoined twin defect after separation during the COVID-19 pandemic
AU - Putri, Nandita Melati
AU - Kreshanti, Prasetyanugraheni
AU - Aulia, Indri
AU - Syarif, Akhmad Noviandi
AU - Tunjung, Narottama
AU - Sukasah, Chaula Luthfia
N1 - Funding Information:
This article was presented at the 5th International Conference and Exhibition on Indonesian Medical Education and Research Institute (5th ICE on IMERI), Faculty of Medicine, Universitas Indonesia. We thank the 5th ICE on IMERI committee, who had supported the peer review and manuscript preparation before submitting it to the journal.
Publisher Copyright:
© 2021 The Author(s)
PY - 2021/7
Y1 - 2021/7
N2 - Introduction: Conjoined twins are a rare medical phenomenon that poses unique challenges for surgeons. Separation of conjoined twins involves multidisciplinary teamwork, complex medical management and surgical planning, and multi-stage operations and often still has a high mortality and morbidity rate. In the times of the COVID-19 pandemic, separation of conjoined twins pose even greater challenges. Aiming for the best outcome possible, while minimizing the risk of COVID transmission and ensuring the safety of the personnel, is paramount. This case report presents thoraco-omphalopagus twins who were successfully separated at 4 months of age. The preoperative planning, operative details, postoperative follow-ups, and outcomes are discussed. Methods: The absence of a tissue expander and the inability to acquire it due to travel restrictions from COVID-19 further complicated the management on this patient. A Routine Polymerase Chain Reaction (PCR) swab test was performed on the patients and personnel. Standardized personnel protective equipment (PPE) was worn during ward and surgical care. After separation of the twins by cardiothoracic and pediatric surgeons, one twin underwent immediate skin closure using a double keystone perforator island flap and a lower abdominal perforator flap. Due to extensive defects, closure was delayed for the second twin. After a series of dressing changes, eventually local perforator flaps could be raised to close the defect using staged tension sutures and skin grafts for secondary defects. Results: Both twins were discharged with no significant morbidity, and no personnel were exposed to COVID-19 infection during the management. Conclusion: Preoperative coordination and planning, multidisciplinary effort, adherence to screening protocols for COVID, and strict use of standardized PPE all contributed to the successful separation of thoraco-omphalopagus conjoined twins during the COVID-19 pandemic.
AB - Introduction: Conjoined twins are a rare medical phenomenon that poses unique challenges for surgeons. Separation of conjoined twins involves multidisciplinary teamwork, complex medical management and surgical planning, and multi-stage operations and often still has a high mortality and morbidity rate. In the times of the COVID-19 pandemic, separation of conjoined twins pose even greater challenges. Aiming for the best outcome possible, while minimizing the risk of COVID transmission and ensuring the safety of the personnel, is paramount. This case report presents thoraco-omphalopagus twins who were successfully separated at 4 months of age. The preoperative planning, operative details, postoperative follow-ups, and outcomes are discussed. Methods: The absence of a tissue expander and the inability to acquire it due to travel restrictions from COVID-19 further complicated the management on this patient. A Routine Polymerase Chain Reaction (PCR) swab test was performed on the patients and personnel. Standardized personnel protective equipment (PPE) was worn during ward and surgical care. After separation of the twins by cardiothoracic and pediatric surgeons, one twin underwent immediate skin closure using a double keystone perforator island flap and a lower abdominal perforator flap. Due to extensive defects, closure was delayed for the second twin. After a series of dressing changes, eventually local perforator flaps could be raised to close the defect using staged tension sutures and skin grafts for secondary defects. Results: Both twins were discharged with no significant morbidity, and no personnel were exposed to COVID-19 infection during the management. Conclusion: Preoperative coordination and planning, multidisciplinary effort, adherence to screening protocols for COVID, and strict use of standardized PPE all contributed to the successful separation of thoraco-omphalopagus conjoined twins during the COVID-19 pandemic.
KW - Case report
KW - COVID-19
KW - Negative pressure wound therapy
KW - Perforator flaps
KW - Thoraco-omphalopagus conjoined twins
UR - http://www.scopus.com/inward/record.url?scp=85109574685&partnerID=8YFLogxK
U2 - 10.1016/j.heliyon.2021.e07443
DO - 10.1016/j.heliyon.2021.e07443
M3 - Article
AN - SCOPUS:85109574685
SN - 2405-8440
VL - 7
JO - Heliyon
JF - Heliyon
IS - 7
M1 - e07443
ER -