Introduction
Conjoined twins are a rare medical phenomenon that poses unique challenges for surgeons. Separation of conjoined twins involves multidisciplinary teamwork, complex medical management and surgical planning, and multi-stage operations and often still has a high mortality and morbidity rate. In the times of the COVID-19 pandemic, separation of conjoined twins pose even greater challenges. Aiming for the best outcome possible, while minimizing the risk of COVID transmission and ensuring the safety of the personnel, is paramount. This case report presents thoraco-omphalopagus twins who were successfully separated at 4 months of age. The preoperative planning, operative details, postoperative follow-ups, and outcomes are discussed.
Methods
The absence of a tissue expander and the inability to acquire it due to travel restrictions from COVID-19 further complicated the management on this patient. A Routine Polymerase Chain Reaction (PCR) swab test was performed on the patients and personnel. Standardized personnel protective equipment (PPE) was worn during ward and surgical care. After separation of the twins by cardiothoracic and pediatric surgeons, one twin underwent immediate skin closure using a double keystone perforator island flap and a lower abdominal perforator flap. Due to extensive defects, closure was delayed for the second twin. After a series of dressing changes, eventually local perforator flaps could be raised to close the defect using staged tension sutures and skin grafts for secondary defects.
Results
Both twins were discharged with no significant morbidity, and no personnel were exposed to COVID-19 infection during the management
Conclusion
Preoperative coordination and planning, multidisciplinary effort, adherence to screening protocols for COVID, and strict use of standardized PPE all contributed to the successful separation of thoraco-omphalopagus conjoined twins during the COVID-19 pandemic.
Introduction : Burn patients as well as the critically ill experience strong oxidative stress, an intense inflammatory response, and a prolonged months-long hypermetabolic and catabolic response that affect nutritional requirements. This study aimed to investigate the nutrition intake in the acute phase from day 1 to day 7 and the correlation with length of stay (LOS) in burn patients in Dr. Cipto Mangunkusumo General Hospital.Method : This cross-sectional study was conducted from January to December 2020 in the Burn Unit of Dr. Cipto Mangunkusumo General Hospital. Research subjects were burns patients who were willing to take part in this research and met the research criteria. The characteristics data included gender, age, burn area, cause of burns, body mass index, and intake analysis were obtained from medical records and were analyzed using Spearman’s correlation and linear regression.Result : A total of 68 subjects were included in this study. There was an increase in energy intake from day 1 to day 7 of 10.81 + 12.73 Kcal/kgBW. There was a significant negative weak correlation between energy changes from day-1 to day-7 and length of stay (r = -0.25, p = 0.03).Conclusion: The higher energy increases within 7 days of treatment, the shorter the LOS of burn patients. Further research is still needed to assess the components that influence nutrition intake and how they impact the clinical outcome of burn patients.
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