Surgery on Twins May Be Delayed
Surgery to separate 11-month-old twins conjoined at the head and facing opposite directions may be delayed several weeks because of complications from a preliminary procedure performed at UCLA on Monday.
Surgeons at Mattel Children’s Hospital implanted a silicone balloon under the scalp of each of the Guatemalan-born twins, Maria de Jesus and Maria Teresa Quiej-Alvarez. Doctors had planned to inject the balloons with saline solution to stretch the skin enough to cover the wound from the final separation surgery.
For the record:
12:00 a.m. June 26, 2002 For The Record
Los Angeles Times Wednesday June 26, 2002 Home Edition Main News Part A Page 2 ..CF: Y 6 inches; 241 words Type of Material: Correction
Twins’ costs--A California section article Tuesday about conjoined twins at UCLA’s Mattel’s Children’s Hospital incorrectly stated that UCLA is donating the costs of the twins’ medical care. The university hopes donations to the fund it set up for the conjoined twin girls will help offset the estimated $1.5-million cost, and the university will make up the difference. Doctors are donating their services. Checks to the UCLA Foundation may be mailed to UCLA Medical Sciences Development, 10945 Le Conte Ave., Suite 3132, Los Angeles, CA 90095.
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But during the procedure, a slight tear was made in the scalp of Maria de Jesus, the smaller twin. Waiting for it to heal could postpone the main separation surgery several weeks past its July 15 scheduled date.
The tear “is going to haunt us in the future,” said Dr. Henry Kawamoto Jr., a specialist in craniofacial reconstructive surgery, who led the procedure. Because scar tissue is not as elastic as regular skin, he fears that as the balloon expands it may rip the scar tissue.
The doctors will not inject the balloon until the tissue can withstand the pressure, and so the twins probably will not have enough skin by July 15 to proceed with the surgery, he said.
Maria de Jesus’ skin is probably a half to three-quarters the thickness of other infants he has treated, Kawamoto said.
The procedure gave the surgical teams the opportunity to work out logistical problems of operating on the girls, whose faces are rotated 120 degrees away from each other.
They arranged the twins on the operating table so that Maria de Jesus was on her stomach, with a horseshoe-shaped pillow under her face to keep her airway clear. Maria Teresa was on her back, supported by rolled towels.
Their hair was shaved to improve access. Anesthesia took two hours and the implantation took one, Kawamoto said.
After the implantation, Kawamoto wrapped the twins’ heads in a clear plastic bandage to cover the balloons’ valves, which protrude from their scalps.
“We don’t want the kids to grab the darn thing and pull it,” he said.
When the balloons expand, the area above their foreheads will swell, forming an inner-tube shape.
Healing the Children, an international charity, flew the twins to UCLA a month ago for the separation surgery and to block off the veins they share. UCLA is donating the estimated $1.5 million in medical costs.
If all goes as planned, this will be the first separation of conjoined twins at UCLA, hospital officials said. Only five other cranial separations have been completed worldwide in the past decade, experts said. Craniopagus twins, or those joined at the head, account for only 2% of all conjoined twins, already a rare population.
At a news conference before the procedure, the twins’ mother, Alba Leticia Quiej-Alvarez, 22, spoke in Spanish through an interpreter. She said she was nervous but added, “Espero en Dios,” I trust in God.
She said the twins differ in what they want to eat, what they want to wear.
“It would be a big shame,” she said, if the separation procedures were not attempted. She could not be reached after the procedure.
