PHILADELPHIA, Oct. 22, 2017 /PRNewswire-USNewswire/ -- Today,
Abby and Erin Delaney are able to
sit independently from one another, be held separately in their
mother and father's arms, and can practice rolling over and
crawling. Such everyday actions are extraordinary for the twin
girls, because up until June 6, they
were connected at the head. Abby and Erin were successfully
separated at Children's Hospital of Philadelphia and are in the
recovery phase of their treatment — continuing to amaze their
family and care team with their resilience and determination.
Born in CHOP's Garbose Family Special Delivery Unit (SDU), the
15-month-old girls, from Mooresville,
N.C., have spent their entire lives living in the Hospital,
until recently when Erin was discharged from CHOP. Abby still
remains in the Hospital.
"Nearly five months after separation, we are happy to announce
that both Erin and Abby Delaney are
doing well as they continue to recover from this very complex
surgery," said neurosurgeon Gregory
Heuer, MD, PhD, who co-led a multidisciplinary team
alongside plastic and reconstructive surgeon Jesse Taylor, MD. In total, approximately 30
individuals helped carry out the complex 11-hour surgery. It
was the 24th time that doctors at CHOP separated a pair
of conjoined twins, more than any other hospital in the Western
Hemisphere.
"This is one of the earliest separations of craniopagus
conjoined twins ever recorded," said Dr. Taylor. "We know that
children heal better and faster the younger they are, therefore our
goal for Erin and Abby was separation as soon as possible with
minimum number of surgeries."
"Although this has been a long journey, with many ups and downs,
Riley and I are thrilled to see how well the girls are doing
today," said Heather Delaney, the
twins' mother. "We are so grateful for the Children's Hospital of
Philadelphia team, and for the
support and encouragement that our families, our friends and the
community have given us during this long journey."
After a Prenatal Diagnosis, Preparing for Separation
Heather and Riley Delaney were told
during a prenatal ultrasound that the twins they were expecting
were joined at the top of their heads, a connection type called
craniopagus conjoined twins. Craniopagus is the least common type
of conjoined twins, accounting for only about 2 percent of cases.
They were quickly referred to the Center for Fetal Diagnosis and
Treatment at CHOP for prenatal care and delivery. Abby and Erin
were born by C-section on July 24,
2016, in CHOP's SDU, a unique unit exclusively for mothers
carrying fetuses with known birth defects. The girls were 10 weeks
premature, each weighing two pounds and one ounce.
Once the babies were born, Dr. Heuer and Dr. Taylor could get an
even clearer picture of precisely how the twins were joined and
developed a plan that would involve a series of procedures over the
several months, ultimately culminating in the separation
surgery.
In October 2016, they operated on
the twins to cut through the bone where the skulls were joined, and
to place a device that would be used to gradually push the two
apart. Called "distraction," the process would add one or two
millimeters of separation a day. Similar procedures had been used
successfully in other types of reconstructive surgery, but this was
a new technique in the separation of conjoined twins. The
distraction process added more than two centimeters of
separation.
Over the next five months, the girls had several more surgeries
as steps toward separation, including the placement of tissue
expanders below the skin where their heads were joined. Like water
balloons, the expanders were gradually filled with fluid to slowly
stretch the skin. The extra skin was needed to cover the gap when
the twins were separated.
While the surgical team worked and planned, Heather and Riley
and the rest of the medical team took care of the twins. The
physical and occupational therapy team at CHOP found creative ways
to help the twins continue to develop, despite being conjoined. One
innovation was a specially built swing large enough to hold both
girls.
Complex Separation Surgery Lasts Over 11 Hours
Months
of preparation culminated during the early morning hours of
June 6, 2017, as the anesthesiology
team, led by Alison Reed Perate, MD,
and Matthew Pearsall, MD, began to
prepare the twins for their separation surgery.
Dr. Taylor first removed the skin expanders. Next, three
neurosurgeons, including Dr. Heuer, worked for hours to separate
the blood flow between the two girls. This required cauterizing
blood vessels and separating their shared dura, the covering of the
brain that lies under the skull. They found that the girls did
share a small amount of brain tissue, and they separated this as
well. More than halfway through the surgery, the teams flipped the
girls, and the surgeons began the same process from the other
side.
As expected, separation of the sagittal sinus, the large vessel
that carries blood from the brain to the heart, was the most
complex part of the surgery. The girls were finally separated at
8:43 p.m. The surgeons then used
artificial material to replace missing skin, and sewed the
stretched skin created by the expanders to cover the gap.
"The ability to plan and carry out this type of surgery is
testament to the skill and expertise available here at Children's
Hospital of Philadelphia," said
N. Scott Adzick, MD, CHOP's
Surgeon-in-Chief. "I'm extremely proud of Dr. Heuer, Dr. Taylor and
the entire CHOP team, and I'm thrilled that Erin and Abby have a
promising future because their courageous parents entrusted their
daughters to our care."
Recovery Continues
Following the separation
surgery, Abby and Erin recovered in CHOP's Pediatric Intensive Care
Unit, later moving to other units of the hospital and finally to
CHOP's rehab unit for more intensive occupational and physical
therapy. The girls were closely followed by their surgeons,
nutritionists, developmental pediatricians, and other specialists
to ensure they received the best clinical care to thrive and grow.
On July 24, they celebrated their
first birthday, receiving more than 300 cards from people around
the world.
Over the next few years, the twins will need additional plastic
and reconstructive surgery to replace the missing bone areas at the
tops of their heads and to normalize their hairlines and minimize
scarring. For now, after spending more than a year at CHOP, their
parents are preparing to take them home to North Carolina sometime later this year.
"The girls are inspiring," said Heather. "As their parents, it
is very neat for Riley and me to have a front row seat to this and
watch them overcome these incredible obstacles. We cannot wait to
see what their future holds!"
Watch this video to hear the girls' story first-hand, as told by
their parents and members of their medical team.
About Conjoined Twins:
Doctors at Children's Hospital
of Philadelphia have separated 24
sets of conjoined twins since 1957, more than any other hospital in
the Western Hemisphere. The physicians have also managed the care
of many others whose separation was not surgically possible.
Conjoined twins occur once in every 50,000 to 60,000 births; most
are stillborn. Approximately 75 percent of conjoined twins are
female and joined at least partially in the chest and share organs
with one another. If they have separate sets of organs, chances for
surgery and survival are greater than if they share the same
organs. Craniopagus, represented by fusion of the skull, is the
least common type of conjoined twins, accounting for 2 percent of
cases.
About Children's Hospital of Philadelphia: Children's Hospital of
Philadelphia was founded in 1855
as the nation's first pediatric hospital. Through its long-standing
commitment to providing exceptional patient care, training new
generations of pediatric healthcare professionals, and pioneering
major research initiatives, Children's Hospital has fostered many
discoveries that have benefited children worldwide. Its
pediatric research program is among the largest in the
country. In addition, its unique family-centered care and
public service programs have brought the 546-bed hospital
recognition as a leading advocate for children and adolescents. For
more information, visit http://www.chop.edu
Contact: Ashley
Moore
Children's Hospital of Philadelphia
Moorea1@email.chop.edu
Cell: 215-630-4683
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SOURCE Children's Hospital of Philadelphia