Carrie Stern, MD, on What It’s Like to Separate Conjoined Twins

Savita Iyer
Stern made the final cut. (Photo courtesy Montefiore Medical Center)
Stern made the final cut. (Photo: Courtesy of Montefiore Medical Center)

Plastic surgery residents in training at Montefiore Medical Center in the Bronx, N.Y., have the opportunity to participate in all the many aspects of the discipline, including craniofacial surgery, complex reconstruction, hand surgery, and aesthetic surgery. But Carrie Stern, MD, a fifth-year postgraduate resident, had a once-in-a-lifetime experience when she made the final cut in the historic, 17-hour craniopagus surgery that successfully separated conjoined, 13-month-old twin boys Jadon and Anias McDonald last Friday.

The highly complex procedure — performed by pediatric neurosurgeon James T. Goodrich, widely acknowledged as the world’s expert on separating twins joined at the head — is rarely performed. Playing a key part in the surgery has left an indelible impression on Stern, and as the McDonald twins continued to recover in-hospital, she was able to reflect back on the historic operation and share her thoughts in an exclusive interview with Yahoo Beauty.

Yahoo Beauty: What exactly is the final cut?
Carrie Stern: At that point, the twins’ brains had been fully separated except for a small skin connection between them that remained. Just prior to this, the most critical portions of large blood vessels and fused brain had been divided by Dr. Goodrich’s neurosurgical team. Dr. [Oren] Tepper then assessed for any remaining areas of scalp that were still connected. After assessing what remained attached, he said, “The final stitch, who wants it?” I eagerly accepted the invitation and, using a pair of surgical scissors, made the final cut. This enabled our teams to then gently pull the two heads apart.

After how many hours of surgery did you perform this final cut, and what were the big steps that had happened before you made it?
Surgery started at 9:45 a.m., and [the twins] were officially separated at 2:11 a.m. the following morning, according to the operative record. The earlier portion of the day was spent working in the areas that had previously been divided during the prior three surgeries. After each of the three [prior] surgeries [the twins had undergone], the bone had been put back, so we had to recut the bones to get access to the brain again and identify the silicone sheets that were temporarily placed between Jadon’s and Anias’s brain to keep them apart.

What was the result of the final cut?
The second part of the operation involved working in areas that had not been touched during the prior procedures and remained attached. This involved separating skin, bone, brain, and blood vessels. The “final cut” was the very last connection that was holding the boys together. After the final cut of skin, they were fully separated.

 

How did you actually make the final cut?
The skin connecting the boys had been stitched together in a previous surgery. To make the final cut, a surgical scissors was used to remove the old stitch and cut the skin bridge that connected the twins.

Can you describe the atmosphere in the operating room for the many hours that the surgery went on? And your feelings about your involvement?
The room was full of excitement, anticipation, and uncertainty about whether the boys could successfully be separated. There was a sense of calm and control, despite the complexity of the operation.

How did you feel about your involvement?
A multitude of people were there to care for Anias and Jadon, and it was incredible to be a part of that. I had been involved peripherally in their care from when they first came to Montefiore. I had the privilege of assisting Dr. Tepper with their third surgery this past August and also had the opportunity to be present for many of the clinic visits and virtual surgical planning sessions that helped to plan their reconstruction. To be present for their final separation was an incredible experience. I am fortunate to have had the opportunity to not only witness the incredible procedure but to also assist Dr. Tepper in this truly once-in-a-lifetime experience.

Was this the first time that you were part of this particular surgical procedure?
Craniopagus separation is an extremely rare operation. So although I have never been involved in this exact type of surgical procedure before, all of the techniques used in this surgery are basic elements of craniofacial reconstruction that are routinely used in other cases.

Now that the surgery is over, what is next for these twins? Will there be any more surgeries?
Time will tell. For now, they are recovering from this major operation. As with any major reconstructive surgery, patients often require revisions.

In what way will you be a part of the postoperative care?
I certainly plan on continuing to be a part of their postoperative care as much as I am able. The entire McDonald family has touched so many people, myself included, and it would be an honor to continue being involved in their incredible journey.

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