R Ricketts | PubMed Health

PubMed1988

Use of skin expansion in separation of conjoined twins.

Successful separation of conjoined twins attached at the thorax and upper abdomen was greatly facilitated by preliminary skin expansion. Recognized problems encountered in traditional methods of wound closure at the separation (including wound breakdown, infection, ventilatory compromise, and obstruction to venous return resulting from tight abdominal skin closure) were avoided through the use of this technique. Technical aspects of expander placement and inflation in conjoined infants are discussed. Skin expansion may represent a major advance in wound management of conjoined twins after surgical separation. This is the second report on the use of skin expansion in conjoined twins and the first involving thoracopagus (twins conjoined at the chest and abdomen).

Dermatologic Surgical Procedures↗

PubMed1986

Biliary atresia: an evolving perspective.

From 1967 to 1984, 50 of our patients with extrahepatic biliary atresia had surgical exploration. Of 40 biliary drainage procedures, bile drained in 21 (52%). Thirty-four patients had portoenterostomy, three had portocholecystostomy, and the most recent six patients had a valved hepatoduodenal conduit. Successful biliary drainage was related to the presence of microscopic ducts at the porta hepatis in 20 of 21 infants. Twenty patients are alive, 12 from two to six years postoperatively (one with a liver transplant). Seven have normal serum bilirubin values. Height and weight exceed the 50th percentile in 5/15 patients studied. Multiple episodes of cholangitis have occurred in 11 patients with portoenterostomy and two with hepatoduodenal conduits. In 12 patients, hemorrhage from the stoma necessitated closure of the stoma before 1 year of age. Five of the six patients with hepatoduodenal conduit are alive two years postoperatively.

Bile Ducts↗