The biggest challenge faced by plastic surgeons involved with conjoint twin separation procedures is having an adequate amount of soft tissue for coverage of the defects created by the separation. One way to create enough skin and soft tissue for the coverage of these defects is to place tissue expanders and to expand them over a period of time prior to the final separation procedure. At Mayo Clinic we have successfully utilized the tissue expander placement, subsequent expansion and separation procedures in a series of five pairs of omphalopagus conjoint twins. Goal: To create standardized guidelines applicable to tissue expansion in omphalopagus conjoint twin separation procedures.

In this study we review the following aspects of tissue expansion: 1. Timing of expander placement. 2. Types of expanders 3. Location of placement 4. Intra-operative approach 5. Post-operative management 6. Timing and the intervals of tissue expansion 7. Imaging studies to assess the amount of new skin required from tissue expansion 8. Use of expanded tissue in final reconstruction