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UCLA Magazine Fall 2002
The Little Marias
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Fall 2002
The Little Marias
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"The 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."

At 1:49 p.m., Kawamoto (bottom) makes the first incision.

But 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."

Finally, 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, Kawamoto says.

The 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.

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