Successful Separation of Conjoined Twins: The Contemporary Experience and Historic Review in Memphis.

Conjoined twins are a rare phenomenon with historically poor outcomes after separation. We present a review of 8 sets of conjoined twins operated on in Memphis, Tenn, from 1953-2016. Except for 1 set of twins, before 2010, all experienced at least 1 fatality either before, during, or as a result of separation. Since 2010, we have separated an additional 2 sets of conjoined twins with no mortality related to the separation, although 1 of the first twins had significant cardiac and respiratory abnormalities and died several years after the separation. Each set of twins presented many challenges in reconstruction; however, the use of tissue expansions in the 2 most recent sets of twins proved to be beneficial. Although improvements in imaging, surgical technology, and postoperative monitoring likely have contributed to the increased survival, previous experience and meticulous planning with a multidisciplinary approach may have been the most influential.