Twins Go Home Today After Fast Recovery
Girls to Have Therapy, Few Restrictions
By David Brown
Washington Post Staff Writer
Friday, July 2, 2004; Page B04
Jade and Erin Buckles, the 4-month-old conjoined twins who were surgically separated June 19, will be discharged from Children's Hospital today.
The 13-day post-operative course has passed without a setback or serious complication, their physicians said yesterday. Both are eating normally and for the last week have been sleeping in the same crib in the hospital's pediatric intensive care unit.
The twins' recovery was "way, way fast," said Gary E. Hartman, the pediatric surgeon who headed the surgical team of about two dozen physicians, nurses, technicians and biomedical engineers. "I kind of didn't let myself think about a recovery like this because I didn't want to jinx us. This is about the smoothest it could happen."
John T. Berger, the intensive care physician and cardiologist who oversaw their post-operative care, said that "given the extensiveness of their surgery, they've had a very, very smooth course."
The babies were able to get off mechanical breathing machines with unusual speed -- Erin in four days and Jade in five. That is about half the time the physicians expected them to be on the machines, and it allowed other aspects of their recovery to go more quickly.
Both girls will get occupational and physical therapy at home to counteract a mild developmental delay and stiffness of joints arising from their four months of relative immobility before the operation.
A flattening of the sides of the girls' skulls -- the result of limited sleeping positions when they were attached -- will correct itself over time, Hartman said. He also believes the chest deformities each girl now has will lessen as they grow. It's not certain they will need more surgery, he said.
There will be few limitations on their activities, other than advising the parents that the babies should not lie on their stomachs, where each had a 6 1/2-inch incision, Berger said.
A major task in the days after extensive surgery is to get the body to eliminate fluid that has leaked out of blood vessels and into surrounding tissue. This condition, known as edema, was relatively mild in the Buckles twins, largely because their surgical blood loss was small. They received relatively little intravenous fluid during the operation and only one transfusion each. The rapid elimination of edema helped them get off the mechanical ventilators quickly, Hartman said.
The girls' parents are Melissa and Kevin Buckles of Woodbridge. Their mother is a high school teacher, and their father a Marine gunnery sergeant stationed in Washington.
Hartman said he expects at least two scientific papers to come out of the team's experience with the Buckles twins.
One will be about the value of three-dimensional models of the infants' internal anatomy, made by Medical Modeling of Golden, Colo. They were fashioned by what are essentially three-dimensional ink jet printers spraying powdered plaster and working from data gathered through CAT and MRI scans.
Erin's heart lay horizontal and was partly in Jade's chest cavity. The models gave the surgeons a clearer sense of what the heart looked like and "reinforced the decision that we would rebuild the chest around" it, Hartman said.
Studying the models also helped persuade the team to delay the operation a week so "tissue expanders" planted under the girls' skin could help them grow more skin. At surgery, the physicians had just enough skin to close the large wounds -- which was crucial to help guard against infection.
The team will also write an article about the elaborate process that preceded the operation. More than 100 people were involved, and team members drew up elaborate flow charts and decision trees outlining the response to virtually every event that could happen during or after surgery.
© 2004 The Washington Post Company