‘Little Marias’ will need plastic surgery

Deena Beasley, Los Angeles

The one-year-old twins, Maria Teresa and Maria de Jesus Quiej-Alvarez, remained in a critical condition with stable vital signs on Tuesday at Mattel Children's Hospital at the University of California at Los Angeles a week after a gruelling 22-hour operation to divide them.

The top of each twin's head is missing a section of skull about the size of an adult hand, Henry Kawamoto, surgical director of UCLA's cranio-facial clinic, said.

Surgeons used skin grafts to cover the girls' brains after separating them.

If their recovery proceeds as expected, the sisters will need surgery to reconstruct their skulls when they reach age five or six, Dr Kawamoto said.

At that time, the twins will need reconstruction of the bone surrounding the brain as well as work to cover bald patches with hair.

Cris Embleton, director of Healing the Children, the nonprofit group that arranged the medical care for the twins, said the children would be taken care of.

"We fully expect to be able to send a team down to Guatemala to finish the surgery," Ms Embleton said.

"You don't put a million dollars of care into a child and just walk away," she said.

"These little girls have stolen our hearts."

UCLA puts its cost of caring for the twins at $1.5million, not including services of the doctors, nurses and others who donated their time.

Aside from the missing skull and hair, the twins' heads and faces because of the way the sisters have been lying are flattened on their left sides and their ears are not aligned.

"With time, all of that will tend to round out," Dr Kawamoto said.

The girls affectionately known as "Las Maritas" or "The Little Marias" were born in rural Guatemala with the tops of their heads fused and their faces tilted in opposite directions.

Surgeons had to separate their skulls and untangle the interconnected blood vessels that drained blood from their brains back to their hearts.

As of Tuesday, Maria Teresa, who underwent a second surgery to remove a blood clot on the brain, lagged behind the more alert Maria de Jesus, but both were moving and responding to outside attention, the hospital said.

The girls' parents, Leticia Alba and Wenceslao Quiej-Alvarez, a banana packer, are from Belen, a hamlet along Guatemala's southern coast where people eke out a living in the banana, sugar and coffee industries.