Management of ischiopagus twin separation with a focus on W–S incision design

Background: Ischiopagus us twins share parts of the spine, central nervous system, gastrointestinal and genitourinary tracts with various degrees of severity. Their separation is a surgical challenge. From the per spective of the plastic surgeon, one of the straightforward technical problems of conjoined twin separation is the coverage of the large residual parietal defects determined by the initial skin incisions.Methods: Here we report the cases of three sets of separated ischiopagus twins and describe the skin incision design. All patients were females aged 4-6 months at the time of surgery. Semi-automatic segmentation and innovative 3D visualization methods were used and surgery planning was based on MRI and CT-scan data.Results: The incision design allowed complete coverage for 2/3 sets of twins and specific strategies were defined to optimize secondary grafting procedures in the remaining set.Conclusions: This report provides a description of relevant incision design strategies for ischiopagus separation to minimize morbidity related to coverage issues, especially in the abdominal and perineal regions.