Early Interest in Research Fuels PLASTIC SURGEON'S GOAL to Give Conjoined Twins Separate Lives
David Staffenberg, M.D. '89, will create skull and bones for the Aguirre twins to shield their heads and provide a normal appearance.
Marjorie Roberts
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"They would surely die if not separated," says David A. Staffenberg, M.D. '89, chief of pediatric plastic surgery at Montefiore Medical Center in the Bronx. "They can't sit or stand and are stuck lying supine. This means they have trouble feeding and swallowing and one has had a high degree of aspiration leading to pneumonia. They are alive due to the expert care of their mother, who is a nurse, and her perseverance, and the care given by the pediatric team at Montefiore's Children's Hospital."
Success is rare
There are no track records for surgeons who attempt to separate children connected as they are; only 2 percent, or 1 in 50, are joined at the top of their heads, Dr. Staffenberg says. Even team leader James Tait Goodrich, M.D., director of pediatric neurosurgery at Montefiore's Children's Hospital, is on a learning curve when he and Dr. Staffenberg make decisions such as which twin will get what blood vessel during the actual procedure. Still, the practice of plastic surgery is not normally an occupation that involves life and death decisions. Explains Dr. Staffenberg, "About 400 years ago an Italian surgeon named Gaspare Tagliacozzi said this about plastic surgeons:
"We restore, repair and make whole those parts which nature has given but fortune has taken away, not so much that they may delight the eye, but that they may buoy up the spirit and help the mind of the afflicted." Separating the Aguirre twins more than qualifies.
"Children who are different are tortured. They don't want to be different. I do everything mindful of helping kids look normal." |
Dr. Staffenberg took over the lead for the May surgery, when their strategy called for stretching the skin on the boys' scalps with tissue expanders to provide enough skin to cover the boys' heads when they are apart; no neurosurgery was involved. Placed beneath the skin, the expanders are balloon-like devices that are gradually inflated by injections of saline. (The twins had tissue expanders in place last fall, but infections led to their removal.) Once separated, the boys will need more plastic surgery to reconstruct their skulls.
Surgeons are not exactly known for doing research, but don't tell that to Dr. Staffenberg. He realized his enthusiasm for research was growing in his second year of medical school, during a summer clerkship with the late Robert Brandstetter, M.D., professor of clinical medicine at affiliated Sound Shore Medical Center in New Rochelle. "Brandstetter was writing a book on pulmonary medicine and he asked me if I would like to write the chapter on bronchiectasis. By my second year of residency at Maimonides [the first year was his internship], I had received permission to do research in an unusual arrangement for two years. So the third and fourth years were practically exclusively for research at New York University, and I really got interested in correcting complex facial deformities-whether caused by trauma, cancer or congenital-when I read The Art of Reconstructive Surgery by Dr. Bert Brent...
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ABOVE: Craniofacial plastic surgeons like David A. Staffenberg, M.D. '89, are among the rarest of medical practitioners, but you wouldn't know it from his role at Montefiore Medical Center. He is more than amazed that he found "this little specialized area of medicine" and wonders how patients found his base of operation so soon. As a result, he is operating non-stop most days; 85 percent are craniofacial cases, his specialty among specialties. The rest are a variety of birth defects and injury-related events suffered by children and adults. |
Solid credentials
So Dr. Staffenberg was credited with four years clinical and two years of research by Maimonides Hospital, a worthy addition to the CV that begins with his birth in what was then New Rochelle Hospital. Having grown up in Larchmont, N.Y., he graduated from Mamaroneck High School and received his undergraduate degree from SUNY-Binghamton. After completing the surgical residency at Maimonides, where doing research helped him make up his mind, he went to Emory University in Atlanta for training in plastic surgery. Afterwards he did a craniofacial surgical fellowship at the University of California at Los Angeles under the direction of Henry Kawamoto, Jr., M.D., D.D.S.
Finished in 1998, Dr. Staffenberg realized that "jobs in craniofacial surgery were hard to find," he says. "It takes about 2 million people to keep one craniofacial surgeon busy." But as luck or talent would have it, a job opened up at Montefiore, which has "one of the oldest centers [opened 1959] for craniofacial surgery in the country. It was amazing that there would be a job 11 miles from my parents! My predecessor, Ravelo Argamaso, had been there 40 years. He walked out the day I walked in, so I was it from day one."
Connection with the Philippines
Someone in the Philippines knew neurosurgeon Goodrich and suddenly there were headlines everywhere about another set of conjoined twins being separated. "The easiest thing for us to have done would be the whole thing at once," admits Dr. Staffenberg. "Surgeons are impatient and we want to get finished. But it would be wrong to have done that if we cared about neurologic impairment." Moreover, there were other considerations:
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ABOVE: Photopolymer models allow him to fine-tune operations before the patient comes to the hospital, says Dr. Staffenberg, referring to a model of whatever structure he will be "fixing" during some of the 8 to 10 plastic surgeries he performs each week. This model becomes a three-dimensional road map of the venous structures shared by the twins, who have separate brains. Because pre-planning of the surgery is more efficient, the model can also cut down actual time in surgery. Created by Medical Modeling LLC in Golden, Col., the model is generated from disks storing MRI and CT-scan model raw data. Like other players in the conjoined twins' story, Medical Modeling has waived its fee. |
It doesn't hurt either that Dr. Staffenberg visits them every day at Blythedale. Sometimes he changes their bandages, but all the while he is watching their progress as the twins attempt to pull themselves up in their crib, or acknowledge each other as they struggle to sit up. He gets no remuneration for it. "Neither does anyone else at Montefiore or Blythedale…I fell into the right hole. We do so many procedures and I love being in New York. It's hard to imagine there is a better place to be," he says.
In a coffee shop in Brentwood, near to where he did the fellowship, Dr. Staffenberg met his wife Nadine from Germiston, just outside Johannesburg in South Africa. They have been married for two years, acknowledging their lives to be incredibly satisfying. And he articulates why: "Most of what I do is cosmetic-cosmetic because all facial reconstruction is essentially cosmetic in nature. Children who are different are tortured. They don't want to be different. I do everything mindful of helping kids look normal."