Pelvic and abdominal wall reconstruction using human acellular dermis in the separation of ischiopagus tripus conjoined twins.

Separating ischiopagus conjoined twins presents the challenge of closing complex pelvic and abdominal wall defects. Traditionally, synthetic mesh has been used to reconstruct large body wall defects. Recent studies demonstrate increased complications while using synthetic mesh for complex musculofasciocutaneous defects. Acellular dermis is a bioprosthetic material that offers advantages over synthetic mesh. These include the ability to become revascularized and remodeled with host tissue, thereby increasing resistance to infection, providing tolerance to overlying skin breakdown, and augmenting strength. The authors describe the use of acellular dermis to reconstruct the pelvic and abdominal walls in the separation of 4-year-old female ischiopagus tripus conjoined twins. Acellular dermis has proven to be effective, as 18 months postoperatively there is no evidence of ventral herniation, wall weakness, or infection. Acellular dermis is a valuable and effective alternative to synthetic mesh for reconstructing large pelvic and abdominal wall defects.