Surgeons successfully separated Allyson and Avery Clark in a surgery Tuesday that took nearly seven hours — more than half of which was prep time spent draping, cleaning and arranging the girls.
Now the babies, who turn 8 months old today, are for the first time resting in separate beds.
Avery was wheeled out of the operating room at 1:54 p.m., and Allyson followed 11 minutes later. They were to spend the night in the intensive-care unit at Primary Children's Medical Center before moving to a regular room later today.
The girls are the daughters of Kerry and Anna Clark. Kerry Clark, 28, is an F-16 crew chief at Hill Air Force Base, and the family, which includes three other girls under age 7, lives on the base.
Kerry Clark was smiling just moments after the operation was finished. "It couldn't be any better. There was no bad news at all," he said.
Asked how his daughters looked, he said it was "kind of strange" to see them separated. "They're a lot skinnier-looking, a lot more compact," he laughed.
When surgeons told the parents that the operation was over, he said his wife, who had been very nervous, got really excited. And he wasn't as calm as he thought he'd be.
"I started shaking, and I'm not really a shaker. I don't get too emotional," he said. "The phone's been ringing like crazy. This is definitely great."
Although they don't know if there will be complications or another procedure or two down the road for the infants, Kerry Clark said, "Everything that can happen from now on is stuff (PCMC doctors) do every day anyway. Simple stuff."
The girls were born joined at the base of their tailbones, and their spinal cords looped down like the letter U and connected. Lead surgeon Dr. John Kestle, a neurosurgeon, said when the doctors opened the infants' dura, the fluid-filled sac that protects the spinal cord, they saw a space with nerves dangling on either side. The surgeons made the cut between those nerves.
"Things went well, we think," Kestle said. "We divided the tissue connecting the spinal cords. We are very happy with what we found. It looked like the connection was below the nerves."
The surgeons had also worried about some large blood vessels in the area of the conjoinment that might be hard to separate, but they were "managed without difficulty," and neither girl required a blood transfusion during the operation. After surgery, they were breathing on their own.
The surgery was a matter of carefully cutting through the layers connecting the two girls, separating skin, fat, connective tissue and a "little tiny bit of bone." The surgeons separated the spinal cords last, cauterized them and then closed the dura. After the cut that separated the girls, Avery was moved to an adjacent operating table, where she was worked on by a separate team of surgeons.
Future complications could include bladder- and bowel-control problems, since the lower spinal cord helps control those functions. The girls could also have some ankle problems for the same reason.
But after surgery, Kestle said the infants were kicking their feet, which is a good sign. As for the bladder and bowel, doctors may not know until the girls are potty-training.
There's also a slight possibility that scar tissue could form around the spinal cord and pin it down, which could also trigger those problems.
Dr. Faizi Siddiqi, a reconstructive and plastic surgeon, said that tissue expanders implanted about six weeks ago provided more than enough skin to cover the wounds, which were closed layer by layer with sutures afterward. The extra skin was left in place, where it will likely shrink back to normal. If it doesn't, it may be removed surgically in six months or so, he said.
He left drains inside the girls temporarily, but closing the wounds was "pretty straightforward." They'll have a scar, but it will be "hopefully a fine line."
When the girls were taken to the operating room at 7:40 a.m., cradled by anesthesiologist Dr. Daniel Evans, Avery and Allyson were smiling, although they hadn't had anything to eat for hours. They were interactive and their "usual happy selves," Kestle said.
When the babies were wheeled past their parents after the surgery, Avery was asleep, but Allyson opened her eyes for a second and looked at them, Kerry Clark said.
He's not going to miss the girls as conjoined twins. "They're heavy. They don't fit anything. Equipment has been our biggest problem. . .. And there are so many things they want to do that they just can't. You can tell they want to roll over or be on their stomachs," he added. "Now I'm curious at how fast they catch up."
In a whimsical touch, one of the surgery technicians made the entire operating team special hats to wear during the surgery, made of material featuring planes and Air Force insignias in honor of Kerry Clark's job as a technical sergeant at Hill.
Kestle said the babies will be sore and likely quiet for a day or two, but when they feel up to it, they can start moving around. He expects they'll be hospitalized about a week.
The Clarks also have three other girls: Rylee, 6, Ryan, 4, and Karlee, 2.
This is the fifth set of conjoined twins separated at Primary Children's. The first was in the late 1970s. The most recent was last August, when teams separated Kendra and Maliyah Herrin, who were 4 at the time.
Timeline
7:40 a.m.: Operating room
10:20 a.m.: First incision
11:26 a.m.: Physical separation
1:54 p.m.: Avery done and heads to pediatric intensive-care unit
2:05 p.m.: Allyson heads to the intensive-care unit
By 2:20 p.m.: Kestle declares the surgery a success
The team
Team members included anesthesiologists Dr. Daniel Evans and Dr. Christopher Miller; neurosurgeons Dr. John Kestle and Dr. Douglas Brockmeyer; plastic and reconstructive surgeons Dr. Faizi Siddiqi and Dr. Courtney Crombie; orthopedic surgeon Dr. Alan Stotts and operating staff including registered nurses Diana Brown, David Giles and Sean Peters; surgical technicians Robin Thompson and Jennifer Pratt; and anesthesia monitor Jason Cox.
E-mail: lois@desnews.com