Ischiopagus twins share parts of the spine, central nervous system, gastrointestinal and genitou-rinary tracts with various degrees of severity. Their separation is a surgical challenge. From the perspective of the plastic surgeon, one of the straightforward technical problems of conjoined twin separation is the coverage of the large residual parietal defects determined by the initial skin incisions.

This report provides a description of relevant incision design strategies for ischiopagus separation in order to minimize morbidity related to coverage issues, especially in the abdominal and perineal regions.

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