The Little Marias
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difficult part, from the plastic-surgery perspective, is to design
the incision," Kawamoto explains. "Once the cut is made,
there is no turning back. And it takes literally hours and hours
and hours of planning."
1:49 p.m., Kawamoto (bottom) makes the first incision.
48 hours before the surgery, Kawamoto and plastic and reconstructive
surgery fellow Mark Urata go to the girls' bedside to see how the
skin flaps they've designed on felt from the plastic skull models
will fit. "It wouldn't work," Kawamoto says. "The
models had been based on the CAT scans two months before, and the
infants grew, but we hadn't taken that into account. Both of us
had such headaches from that." Kawamoto and Urata return the
next day and "knock out new flaps within an hour."
all the preparations are completed and the girls are ready for surgery.
At 1:49 p.m., Kawamoto makes the delicate first incision. He and
his team slice the scalp in such a way as to ensure that when the
separation portion of the surgery is completed, the skin flaps will
fold back over the top of each child's head to cover the brains.
It is a major point; in some previous separation attempts of craniopagus
twins when there was not enough skin, the babies did not do well,
plastic surgeons must also synchronize the area to be opened with
the neurosurgeons. "We know that if we are off just a little
bit, that error can be fatal," Kawamoto continues. "That's
how critical it is." Using the Doppler wand, doctors listen
to the woo-woo-woo sounds of the veins and the lower pitch of the
arteries, identifying their locations and marking them in blue ink
for the veins and red for the arteries.