SUCCESSFUL SEPARATION OF ISCHIOPAGUS TRIPUS CONJOINED TWINS WITH COMPARATIVE-ANALYSIS OF METHODS FOR ABDOMINAL-WALL CLOSURE AND USE OF THE TRIPUS LIMB

The authors report the successful delivery, preoperative management, a nd postoperative courses of ischiopagus tripus twin girls successfully separated at 5 months of age. Surgical objectives were predicated on survival and optimum postseparation reconstructive potential for both girls. Each twin has subsequently undergone additional procedures, and both are doing well 2 years after separation. The authors reviewed 17 known cases of ischiopagus tripus separation, comparing anatomic find ings, use of the tripus limb, operative strategies, and attainment of abdominal closure. This 18th case includes the first report of splitti ng the tripus limb and giving each girl a femur. The authors found tha t detailed systemic investigation, advanced coordinated teamwork with appropriate technical support, applications of new technologies or rea pplication of existing technologies, meticulous planning, and favorabl e anatomy were vital in yielding favorable outcomes. Copyright (C) 199 7 by W.B. Saunders Company.