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Chim H, Arcelona C, Gosain AK. Scalp Closure in Midline Cutis Aplasia-An Absolute Indication for Preoperative Imaging. J Craniofac Surg 2024; 35:e345-e347. [PMID: 38393191 DOI: 10.1097/scs.0000000000010062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 01/30/2024] [Indexed: 02/25/2024] Open
Abstract
The ideal evaluation and treatment of aplasia cutis congenita remains disputed. We present a case of midline scalp cutis aplasia that healed by secondary intention, leaving an area of residual alopecia. There were no clinical indicators of an underlying calvarial defect. Tissue expansion of the scalp was done in preparation for scalp closure. However, on the removal of the expanders and scalp advancement, an unrecognized midline calvarial defect in which a scar tract of herniated dura was found. This resulted in a dural tear, repaired with minimal hemorrhage. However, manipulation of the sagittal sinus resulted in a right subdural hemorrhage followed by cerebral ischemia and a stroke. On the basis of this clinical scenario, we recommend that all cases of midline scalp cutis aplasia undergo preoperative imaging with thin slices of the calvaria before performing scalp advancement-even if the only clinical indication for surgery is scalp alopecia without a palpable skull defect.
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Affiliation(s)
- Harvey Chim
- Division of Plastic Surgery, University of Florida School of Medicine, Gainesville, FL
| | - Christian Arcelona
- Division of Plastic Surgery, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Arun K Gosain
- Division of Plastic Surgery, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL
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2
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Jumei'an A, Ababneh H, Jaradat M, Omari A, Aljbour M, Aljader M, Albadaineh R, Alsaket G, Al Bdour M. A Closer Look at Aplasia Cutis Congenita: Understanding a Unique Case. Cureus 2024; 16:e61516. [PMID: 38957254 PMCID: PMC11217913 DOI: 10.7759/cureus.61516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2024] [Indexed: 07/04/2024] Open
Abstract
Aplasia cutis congenita (ACC) is a rare congenital disease defined by the absence of skin, most commonly on the scalp. While the exact incidence remains uncertain, ACC presents a significant challenge in clinical management due to its variable presentation and associated complications. We present the case of a newborn male with a large scalp defect attributed to ACC, complicated by a life-threatening scalp hemorrhage. Despite challenges in management, including recurrent infections and failed skin grafts, the patient ultimately achieved satisfactory healing following a series of surgical interventions, including local transposition flap procedures. This case underscores the importance of a multidisciplinary approach to managing ACC, tailored to individual patient characteristics and associated risks. While discrete lesions of ACC typically have a favorable prognosis, extensive defects pose significant risks of morbidity and mortality, highlighting the need for careful consideration of treatment options and close clinical monitoring of affected individuals.
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Affiliation(s)
- Ala' Jumei'an
- Plastic and Reconstructive Surgery, Royal Medical Services, Amman, JOR
| | - Hamza Ababneh
- Plastic and Reconstructive Surgery, Royal Medical Services, Amman, JOR
| | - Mahmoud Jaradat
- Plastic and Reconstructive Surgery, Royal Medical Services, Amman, JOR
| | - Ahmad Omari
- Plastic and Reconstructive Surgery, Royal Medical Services, Amman, JOR
| | - Mohammad Aljbour
- Plastic and Reconstructive Surgery, Royal Medical Services, Amman, JOR
| | - Mutaz Aljader
- Plastic and Reconstructive Surgery, Royal Medical Services, Amman, JOR
| | - Reham Albadaineh
- Plastic and Reconstructive Surgery, Jordan University Hospital, Amman, JOR
| | - Gaith Alsaket
- Plastic and Reconstructive Surgery, Jordan University Hospital, Amman, JOR
| | - Mohammad Al Bdour
- Plastic and Reconstructive Surgery, Royal Medical Services, Amman, JOR
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Scotti A, Benanti E, Augelli F, Baruffaldi Preis FW. A Case of Large Aplasia Cutis Congenita with Underlying Skull Defect: Effective Surgical Treatment with Integra® Dermal Regeneration Template. Pediatr Neurosurg 2021; 56:268-273. [PMID: 33827083 DOI: 10.1159/000512022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/04/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Aplasia cutis congenita (ACC) is a rare congenital abnormality characterized by the absence of a portion of skin at birth which most commonly involves the scalp and can affect the galea, the pericranium, the bone, and the dura mater. It can be an isolated condition or associated with other disorders. CASE REPORT We present a case of ACC with a large defect of the scalp and the underlying bone treated with the use of Integra® Dermal regeneration template. At 5 months of follow-up, the wound is completely healed and the bony defect greatly reduced. Contraction of the area of alopecia was observed. DISCUSSION Several surgical and conservative options have been described to treat this congenital condition: advanced dressing, skin graft, local flaps, free flaps, and other methods. In our case, we used Integra® Dermal templates which provide a barrier for infections, promote cellular activity for a rapid vascularization, and improve healing.
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Affiliation(s)
- Andrea Scotti
- Department of Plastic Surgery, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Elisa Benanti
- Department of Plastic Surgery, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Federica Augelli
- Department of Plastic Surgery, Niguarda Ca' Granda Hospital, Milan, Italy
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Wehrens KM, De Jongh F, Ter Laak MP, Cornips EM, Van der Hulst R. Treatment of a Large Skull Defect and Brain Herniation in a Newborn With Adams-Oliver Syndrome. Cureus 2020; 12:e7047. [PMID: 32211278 PMCID: PMC7083258 DOI: 10.7759/cureus.7047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Adams-Oliver syndrome (AOS) is a rare congenital disorder characterised by a wide variety of clinical expression ranging from the occurrence of aplasia cutis congenita (ACC), transverse limb defects, and cutis marmorata telangiectica to extensive lethal anomalies. In this article, we present the conservative and surgical management of a male newborn infant diagnosed with AOS. Surgical treatment included wound management, the removal of protruding brain, and treatment of cerebrospinal fluid (CSF) leakage. After spontaneous reepithelization of the wounds, conservative treatment was chosen instead of reconstruction with an occipital flap; this was continued until the total healing of the dermal defect after eight months, during which the patient was continuously treated with antibiotics. At 17 months, the child was in good physical condition with a three-month development delay in comparison with infants of his age and no evidence of neurological deficit.
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Affiliation(s)
- Kim M Wehrens
- Plastic Surgery, Haaglanden Medisch Centrum, The Hague, NLD
| | - Frank De Jongh
- Plastic Surgery, Haaglanden Medisch Centrum, The Hague, NLD
| | - M P Ter Laak
- Neurosurgery, Maastricht University Medical Center, Maastricht, NLD
| | - E M Cornips
- Neurosurgery, Maastricht University Medical Center, Maastricht, NLD
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An Aplasia Cutis Congenita: Suggestion of Management Algorithm. J Craniofac Surg 2019; 30:2493-2496. [PMID: 31609940 DOI: 10.1097/scs.0000000000005874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND When a child is born with Aplasia cutis congenita (ACC), it is important for the surgeon to decide promptly whether to perform early surgical intervention, or proceed with conservative care. Several patients of ACC have been reported in which various treatments have attempted. However, the criteria of treatment remain controversial. In this study, the authors present an algorithm and the literature review to assist with objective decisions during ACC management. METHODS A total of 4 cases of infants born with ACC were referred to our department between January 2017 and April 2019. Conservative care was to be considered a first choice of management. RESULTS The ACC lesions were presented in the scalp vertex area in all 4 infants with the intact dura mater. There was no large vein exposure or sagittal sinus exposure in all infants. All 4 infants were managed with conservative care, which immediately resulted in complete healing of the defects without any complications. CONCLUSIONS Rapid decision-making is required whether or not the patient requires emergency surgical coverage. Even extensive defects may be healed by conservative care alone, if the dura mater is intact and accompanying large vein or sagittal sinus exposure is not identified.
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Blionas A, Giakoumettis D, Antoniades E, Drosos E, Mitsios A, Plakas S, Sfakianos G, Themistocleous MS. Aplasia cutis congenita: Two case reports and discussion of the literature. Surg Neurol Int 2017; 8:273. [PMID: 29204308 PMCID: PMC5691551 DOI: 10.4103/sni.sni_188_17] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Accepted: 08/23/2017] [Indexed: 11/04/2022] Open
Abstract
Background: Aplasia cutis congenita (ACC) is a part of a heterogeneous group of conditions characterized by the congenital absence of epidermis, dermis, and in some cases, subcutaneous tissues or bone usually involving the scalp vertex. There is an estimated incidence of 3 in 10,000 births resulting in a total number of 500 reported cases to date. The lesions may occur on every body surface although localized scalp lesions form the most frequent pattern (70%). Complete aplasia involving bone defects occurs in approximately 20% of cases. ACC can occur as an isolated defect or can be associated with a number of other congenital anomalies such as limb anomalies or embryologic malformations. In patients with large scalp and skull defects, there is increased risk of infection and bleeding along with increased mortality and therefore prompt and effective management is advised. Case Description: We describe two cases of ACC, involving a 4 × 3 cm defect managed conservatively and a larger 10 × 5 cm defect managed surgically with the use of a temporo-occipital scalp flap. Both cases had an excellent outcome. Conclusions: Multiple treatment regimens exist for ACC, but there is no consensus on treatment strategies. Conservative treatment has been described and advocated, but many authors have emphasized the disadvantages of this treatment modality. Decision between conservative and surgical management must be individualized according to lesion size and location.
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Affiliation(s)
- Alexandros Blionas
- Department of Neurosurgery, Asklepieion Hospital of Voula, Voula, Greece
| | - Dimitrios Giakoumettis
- Department of Neurosurgery, University of Athens Medical School, "Evangelismos" General Hospital, Athens, Greece
| | - Elias Antoniades
- Department of Neurosurgery, University of Thessaloniki Medical School, "AHEPA" University Hospital, Thessaloniki, Greece
| | - Evangelos Drosos
- Department of Neurosurgery, University of Athens Medical School, "Evangelismos" General Hospital, Athens, Greece
| | - Andreas Mitsios
- Department of Neurosurgery, Children's Hospital "Agia Sofia", Athens, Greece
| | - Sotirios Plakas
- Department of Neurosurgery, Kings College Hospital NHS Foundation Trust, London, UK
| | - Georgios Sfakianos
- Department of Neurosurgery, Children's Hospital "Agia Sofia", Athens, Greece
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Clinical Application of Acellular Dermal Matrix in the Treatment of Aplasia Cutis Congenita on Scalp. J Craniofac Surg 2017; 28:e788-e789. [DOI: 10.1097/scs.0000000000004050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Technique for Management of Aplasia Cutis Congenita of the Scalp With a Skin Allograft. J Craniofac Surg 2016; 27:1049-50. [DOI: 10.1097/scs.0000000000002610] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Gencel E, Eser C, Tabakan I, Kesiktas E, Yavuz M. Outcomes of Tissue Expander Application for Scalp Reconstruction in Extensive Aplasia Cutis Congenita. Aesthetic Plast Surg 2016; 40:114-9. [PMID: 26537513 DOI: 10.1007/s00266-015-0584-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 10/21/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Aplasia cutis congenita (ACC) is a rare congenital disorder. The purpose of this study was to present outcomes of tissue expander application for scalp reconstruction in extensive ACC. PATIENT/METHODS In this retrospective study, medical records were reviewed for six patients who underwent serial tissue expander application for scalp reconstruction in ACC between 2000 and 2015. Patient average age was 14.5 (range, 4-25 years). One of the six cases had frontal bone defect, the others had bone and soft tissue defect at the vertex. In the newborn period, all patients have been managed by split-thickness skin grafts without cranioplasty procedures. After grafting and calvarial regeneration, one (or more) sessions of tissue expanders and scalp flap applications were performed for alopecia and soft tissue correction. Radiologic and clinical examination was performed for complications and outcomes. RESULTS Computerized tomography showed intact calvarium with patchy hyperostosis in all patients. The mean size of grafted areas was 69.5 cm(2) (range, 32-148.5 cm(2)). Minimal distal flap necrosis (6 × 1 cm) was observed in one patient. Serial scalp tissue expansion was performed with at least one session in a 1-year interval. One expander was extracted due to exposition and infection. No total flap losses and no calvarial defects were observed during follow-up (mean; 8.6 years). Clinical examination revealed acceptable cosmetic results in all patients. CONCLUSION We advocate late expander scalp reconstruction for management of extensive ACC cases. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Eyuphan Gencel
- Department of Plastic, Reconstructive and Aesthetic Surgery, Cukurova University Medical School, 01330, Saricam, Adana, Turkey.
| | - Cengiz Eser
- Department of Plastic, Reconstructive and Aesthetic Surgery, Cukurova University Medical School, 01330, Saricam, Adana, Turkey
| | - Ibrahim Tabakan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Cukurova University Medical School, 01330, Saricam, Adana, Turkey
| | - Erol Kesiktas
- Department of Plastic, Reconstructive and Aesthetic Surgery, Cukurova University Medical School, 01330, Saricam, Adana, Turkey
| | - Metin Yavuz
- Department of Plastic, Reconstructive and Aesthetic Surgery, Cukurova University Medical School, 01330, Saricam, Adana, Turkey
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Winston KR, Ketch LL. Aplasia Cutis Congenita of the Scalp, Composite Type: The Criticality and Inseparability of Neurosurgical and Plastic Surgical Management. Pediatr Neurosurg 2016; 51:111-20. [PMID: 26937970 DOI: 10.1159/000442989] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 12/01/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS The object of this report is to review the management of patients having the composite type of aplasia cutis congenita in the context of the relevant literature on this condition. METHODS Clinical records, neuroimaging and photographic documentation of identified cases of composite type aplasia cutis congenita, with a comprehensive review of the literature, are the material basis of this report. RESULTS Two neonates with composite type aplasia cutis congenita are described as examples of this disorder, and their management, including complications, is discussed. Both had satisfactory outcomes. CONCLUSIONS Early aggressive surgical management with scalp rotation flaps has a low rate of complications, provides satisfactory functional and esthetic outcome, minimizes hospital stays, and should provide cost-effective care by reduction of the time to secure wound closure. Most bony defects, even large ones, commonly ossify completely. Optimal case management requires a synchronized neurosurgical and plastic surgical team. Intuitive nonsurgical and surgical approaches by the inexperienced can be hazardous.
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Affiliation(s)
- Ken R Winston
- Department of Neurosurgery, University of Colorado Denver School of Medicine, Aurora, Colo., USA
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Betancourth-Alvarenga J, Vázquez-Rueda F, Vargas-Cruz V, Paredes-Esteban R, Ayala-Montoro J. Manejo quirúrgico de la aplasia cutis congénita. An Pediatr (Barc) 2015; 83:341-5. [DOI: 10.1016/j.anpedi.2015.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 01/28/2015] [Accepted: 02/09/2015] [Indexed: 11/25/2022] Open
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Betancourth-Alvarenga J, Vázquez-Rueda F, Vargas-Cruz V, Paredes-Esteban R, Ayala-Montoro J. Surgical management of aplasia cutis congenita. An Pediatr (Barc) 2015. [DOI: 10.1016/j.anpede.2015.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Liu Y, Qiu L, Fu Y, Tian X, Yuan X, Xiao J, Li T. Large defects in aplasia cutis congenita treated by large-sized thin split-thickness skin grafting: long-term follow-up of 18 patients. Int J Dermatol 2015; 54:710-4. [PMID: 26010404 DOI: 10.1111/ijd.12773] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 05/29/2014] [Accepted: 06/02/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the long-term results of using surgical large-sized thin split-thickness skin grafting to treat aplasia cutis congenita (ACC) in neonates. METHODS This study included 18 ACC neonates with large skin defects who underwent large-sized thin split-thickness skin grafting at our hospital from March 2002 to November 2011. The size of the lesion was >10% of the total body surface area (TBSA) in 16 patients, 7% of TBSA in one patient, and 3% of TBSA in another patient. The size of the skin graft was designed to be equal to or slightly larger than the size of the lesion. RESULTS Skin grafts in 16 patients who were followed for periods of 6 months-7 years after surgery showed good survival; however, two patients were lost to follow-up. The wound healed completely without scarring in five patients. One of the five patients who healed without scarring had failed previous conservative treatment. Several mild hypertrophic scars occurred in one patient, and flat, thin, shiny, soft, parchment-like scars were noted in five other patients. Dark red, hard, raised hypertrophic scars occurred in five patients who had partial necrosis in the skin graft after surgery. CONCLUSION A large-sized thin split-thickness skin graft can be used to effectively close a wound and permit healing to occur with reduced long-term scarring. This procedure is ideal for treating skin defects in patients with ACC.
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Affiliation(s)
- Yan Liu
- Department of Burns and Plastic Surgery, Children's Hospital of Chongqing Medical University and Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing (CSTC2009CA5002), Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, China
| | - Lin Qiu
- Department of Burns and Plastic Surgery, Children's Hospital of Chongqing Medical University and Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing (CSTC2009CA5002), Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, China
| | - Yuexian Fu
- Department of Burns and Plastic Surgery, Children's Hospital of Chongqing Medical University and Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing (CSTC2009CA5002), Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, China
| | - Xiaofei Tian
- Department of Burns and Plastic Surgery, Children's Hospital of Chongqing Medical University and Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing (CSTC2009CA5002), Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, China
| | - Xingang Yuan
- Department of Burns and Plastic Surgery, Children's Hospital of Chongqing Medical University and Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing (CSTC2009CA5002), Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, China
| | - Jun Xiao
- Department of Burns and Plastic Surgery, Children's Hospital of Chongqing Medical University and Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing (CSTC2009CA5002), Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, China
| | - Tianwu Li
- Department of Burns and Plastic Surgery, Children's Hospital of Chongqing Medical University and Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing (CSTC2009CA5002), Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, China
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Fatal superior sagittal sinus hemorrhage as a complication of aplasia cutis congenita: a case report and literature review. Forensic Sci Med Pathol 2015; 11:243-8. [PMID: 25614301 DOI: 10.1007/s12024-014-9645-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2014] [Indexed: 10/24/2022]
Abstract
Aplasia cutis congenita (ACC) is a rare condition that occurs in around 0.01% of births. Characterized by a localized absence of skin, it affects the midline of the scalp in over 80% of cases. We describe the case of an infant born via vaginal spontaneous delivery with ACC affecting the scalp. This extended to the subcutaneous tissue and bone leaving the dura mater exposed. The patient was managed conservatively. At 4 weeks of age, she had a fatal superior sagittal sinus hemorrhage. In a review of the literature, we found ten previous cases of hemorrhage of the superior sagittal sinus complicating an ACC. Including our case, ACC complicated by hemorrhage of the superior sagittal sinus shows a 36% mortality (4/11). An analysis of these cases suggests that this tends to occur between 1 and 3 months of age, though it may occur in younger neonates.
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Fröjd V, Maltese G, Kölby L, Tarnow P. Conservative Healing of an 11 × 9-cm Aplasia Cutis Congenita of the Scalp with Bone Defect. J Neurol Surg Rep 2014; 75:e220-3. [PMID: 25485218 PMCID: PMC4242817 DOI: 10.1055/s-0034-1387195] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 06/30/2014] [Indexed: 11/13/2022] Open
Abstract
Objectives Aplasia cutis congenita is a rare congenital condition, and it is difficult to find scientific support for optimal treatment strategies. In addition, these may vary due to defect size, tissue layers involved, contemporary malformations, and the physiologic status of the affected child. Clinical Presentation This case report describes complete skin coverage in 20 weeks and uneventful healing of a large 11 × 9-cm defect of the vertex, involving both skin and skull bone, using conservative treatment. To prevent infection and promote healing, the defect was kept moist and covered at all times, and it was treated with surgical debridement when necessary. For infection control, ionized silver-coated dressings were used in addition to prophylactic antibiotics over the first 3.5 weeks. Follow-up was 2 years. Conclusion Surgical treatment is usually preferred for larger aplasia cutis congenita defects, but it is accompanied with potential risks and will exacerbate secondary reconstruction of alopecia or skull bone defects. This case shows that even very complex defects may be treated conservatively.
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Affiliation(s)
- Victoria Fröjd
- The Craniofacial Unit, Department of Plastic and Reconstructive Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Giovanni Maltese
- The Craniofacial Unit, Department of Plastic and Reconstructive Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars Kölby
- The Craniofacial Unit, Department of Plastic and Reconstructive Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Peter Tarnow
- The Craniofacial Unit, Department of Plastic and Reconstructive Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
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Parental allografts in the management of Adams-Oliver syndrome. Childs Nerv Syst 2013; 29:1223-4. [PMID: 23740178 DOI: 10.1007/s00381-013-2174-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Accepted: 05/16/2013] [Indexed: 10/26/2022]
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Affiliation(s)
- Ji Young Kim
- Department of Pediatrics, Cheil General Hospital, College of Medicine, Kwandong University, Seoul, Korea
| | - Yeon Kyung Lee
- Department of Pediatrics, Cheil General Hospital, College of Medicine, Kwandong University, Seoul, Korea
| | - Sun Young Ko
- Department of Pediatrics, Cheil General Hospital, College of Medicine, Kwandong University, Seoul, Korea
| | - Kyung A Kim
- Department of Pediatrics, Cheil General Hospital, College of Medicine, Kwandong University, Seoul, Korea
| | - Son Moon Shin
- Department of Pediatrics, Cheil General Hospital, College of Medicine, Kwandong University, Seoul, Korea
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Magro E, Oillic H, Dam-Hieu P, Forlodou P, Besson G, Seizeur R. Aplasia cutis congenita du vertex avec atteinte osseuse : synthèse sur la prise en charge et revue de la littérature. Neurochirurgie 2010; 56:415-9. [DOI: 10.1016/j.neuchi.2010.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Accepted: 03/19/2010] [Indexed: 11/30/2022]
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Tröbs RB, Barenberg K, Hemminghaus M, Günther M, Neid M. Herniation of the brain after conservative treatment of a large congenital skull defect in an infant with Adams-Oliver syndrome. J Pediatr Surg 2010; 45:2064-7. [PMID: 20920732 DOI: 10.1016/j.jpedsurg.2010.06.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2009] [Revised: 05/22/2010] [Accepted: 06/13/2010] [Indexed: 10/19/2022]
Abstract
We report the case of a newborn baby with a large congenital skull defect owing to Adams-Oliver syndrome. An initial attempt at conservative treatment failed and led to disruption of the leptomeningeal membrane and prolapse of the brain. After local debridement, delayed and stepwise surgical closure was complicated by cerebrospinal fluid leakage, which required the insertion of a cerebrospinal fluid shunt. This case report highlights the potential serious risks of nonsurgical management of largely extended congenital skull defects.
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Affiliation(s)
- Ralf-Bodo Tröbs
- Department of Pediatric Surgery, Catholic Foundation Marienhospital Herne, Ruhr-University of Bochum, Widumer Str 8, D-44627 Herne, Germany.
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Abstract
Aplasia cutis congenita is a rare, sporadic congenital malformation characterized by skin defects, sometimes extending to the underlying bone. We report a case of a boy born with a large rhomboid scalp and skull defect measuring 8 × 12 cm with no other anomalies. Conservative treatment led to the complete epithelization of the skin defect with secondary closure of the cranial vault without need for surgical intervention.
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Affiliation(s)
- Mirta Starcevic
- Department of Pediatrics, Sestre Milosrdnice University Hospital Zagreb, Zagreb, Croatia.
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Rios LTM, Martins MDG, Simões VMF, Nunes MDV, Marques PF, Godoy SHCDS. Acalvaria primária: relato de caso. Radiol Bras 2010. [DOI: 10.1590/s0100-39842010000400013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Acalvaria é uma malformação congênita rara de patogênese desconhecida, na qual os ossos da abóbada craniana, a dura-máter e a musculatura associada estão ausentes, mas o sistema nervoso central costuma estar preservado. A teoria fisiopatogênica mais aceita sugere um defeito pós-neurulação, com disposição normal do ectoderma embrionário. O objetivo deste relato é descrever os achados de imagem neonatais da acalvaria primária.
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Burkhead A, Poindexter G, Morrell DS. A case of extensive Aplasia Cutis Congenita with underlying skull defect and central nervous system malformation: discussion of large skin defects, complications, treatment and outcome. J Perinatol 2009; 29:582-4. [PMID: 19638992 DOI: 10.1038/jp.2008.250] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Aplasia Cutis Congenita (ACC) is a rare condition characterized by the absence of a portion of skin at birth. Skin defects are usually small (0.5 to 3 cm) and located on the scalp. Although there can be other physical or genetic abnormalities, ACC is most often a benign isolated condition. Rarely is an underlying bony defect present, and this association increases the rate of complications. We report a case of a newborn male with ACC of the entire crown and vertex scalp, non-ossified parietal skull and dysplastic corpus callosum. The patient's skull and skin defects were treated non-surgically, and he recovered well.
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Affiliation(s)
- A Burkhead
- University of North Carolina School of Medicine, Chapel Hill, NC 27599-9535, USA.
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Beekmans SJA, don Griot JPW, Niessen FB, Mulder JW. Tissue expansion for correction of baldness in aplasia cutis congenita. Eur J Pediatr 2009; 168:541-4. [PMID: 18633641 DOI: 10.1007/s00431-008-0784-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2008] [Accepted: 06/17/2008] [Indexed: 10/21/2022]
Abstract
UNLABELLED Aplasia cutis is a congenital absence of the skin, usually presenting on the scalp. In 20% of all cases, part of the skull is also absent. A residual area of baldness may still be present some years after surgical or conservative treatment. It is possible to excise the scarred hairless region and cover that area with expanded hair-bearing skin from the rest of the skull. We present three patients who underwent tissue expansion and discuss the indications and pitfalls of this procedure. CONCLUSION Tissue expansion can be used to cover a residual alopecia defect in young children with aplasia cutis congenita and associated bone abnormalities. The quality of the bone appears to be normal in our three patients. We demonstrate that even in young children with aplasia cutis and an underlying bony defect, tissue expansion is a safe and effective modality as a second stage reconstruction procedure.
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Affiliation(s)
- S J A Beekmans
- Department of Plastic, Reconstructive and Hand Surgery, Vrije Universiteit Medical Center, De Boelelaan 1117, 1007 MB Amsterdam, The Netherlands.
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Aplasia Cutis Congenita with Calvarial Defects: A Simplified Management Strategy Using Acellular Dermal Matrix. Plast Reconstr Surg 2008; 121:1224-1229. [DOI: 10.1097/01.prs.0000302588.95409.fe] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Beekmans SJA, Don Griot JPW, Mulder JW. Split Rib Cranioplasty for Aplasia Cutis Congenita and Traumatic Skull Defects. J Craniofac Surg 2007; 18:594-7. [PMID: 17538324 DOI: 10.1097/scs.0b013e3180576f44] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aplasia cutis is a rare skin defect usually presenting over the vertex of the skull. An underlying bone defect is found in approximately 20% of patients. Most skull defects close spontaneously. However, when there are no signs of ossification, closure is mandatory. We present our experience in three patients. Our first patient had an aplasia cutis with a skull defect. The split rib graft procedure was used without complications, and a good cosmetic and functional result was achieved. The second patient was operated on for cerebral bleeding after an arteriovenous aneurysm, and a bony defect could not be closed after that procedure. At a later stage, the defect was filled with split rib grafts, and sufficient protection was achieved and documented after more than 30 years. The third patient was born with an aplasia cutis congenita with a skull defect. The bony defect was filled with split rib grafts without complications at an age of 5 years. Follow-up shows a functional result with a firm skull. Patients with aplasia cutis may have skull defects that will not close by themselves. We present three patients with a bony defect who were reconstructed with split rib grafts. After a long period of follow-up, there remains good cosmetic and functional results. Defects of the skull in children can be reconstructed with split rib grafts that will accommodate the growing skeleton and give good protection of the brain from an early age on.
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Affiliation(s)
- Sander J A Beekmans
- Department of Plastic and Reconstructive Surgery, Vrije Universiteit Medical Center, Amsterdam, The Netherlands.
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Nasir S, Aydin MA, Gülgönen A. Nondigital tissue replantation and microsurgical spare part utilization in mutilated hands: case reports and review. Microsurgery 2007; 27:65-73. [PMID: 17290374 DOI: 10.1002/micr.20309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Five cases with microsurgical utilization of spare parts from unreplantable amputated segments are presented. Besides, nondigital composite tissue replantations are firstly reported in hand. They all resulted in satisfactory outcomes compared to alternative treatments without any donor site morbidity.
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Affiliation(s)
- Serdar Nasir
- Department of Plastic and Reconstructive Surgery, Süleyman Demirel University School of Medicine, Isparta, Turkey.
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Santos de Oliveira R, Barros Jucá CE, Lopes Lins-Neto A, Aparecida do Carmo Rego M, Farina J, Machado HR. Aplasia cutis congenita of the scalp: is there a better treatment strategy? Childs Nerv Syst 2006; 22:1072-9. [PMID: 16639628 DOI: 10.1007/s00381-006-0074-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2005] [Indexed: 11/26/2022]
Abstract
BACKGROUND Aplasia cutis congenita (ACC) is a rare disease of unknown etiology, involving any site of the body. The scalp is the most frequent location, followed by the forearms, knees, both sides of the trunk, and neck, in decreasing order of frequency. Superficial lesions may heal spontaneously and seldom result in morbidity or mortality. However, in patients with large scalp and skull defects, there are risks of infection and bleeding. Conservative treatment has been described and advocated, but some authors have highlighted the disadvantages of this treatment modality. On the other hand, several authors claim that aggressive surgical treatment has an important role for large defects. MATERIALS AND METHODS In this paper, we report three newborns with ACC of the scalp, two large defects and a medium one, respectively, treated conservatively and surgically. CONCLUSION The management of ACC of the scalp is still controversial. Our series suggests that conservative treatment should be performed for initial management in newborns.
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MESH Headings
- Abnormalities, Multiple/diagnosis
- Abnormalities, Multiple/genetics
- Abnormalities, Multiple/mortality
- Bone Transplantation
- Child, Preschool
- Diseases in Twins/diagnosis
- Diseases in Twins/mortality
- Diseases in Twins/surgery
- Ectodermal Dysplasia/diagnosis
- Ectodermal Dysplasia/genetics
- Ectodermal Dysplasia/mortality
- Ectodermal Dysplasia/surgery
- Female
- Humans
- Image Processing, Computer-Assisted
- Imaging, Three-Dimensional
- Infant
- Infant, Newborn
- Infant, Premature, Diseases/diagnosis
- Infant, Premature, Diseases/mortality
- Infant, Premature, Diseases/surgery
- Postoperative Complications/etiology
- Postoperative Complications/mortality
- Scalp/abnormalities
- Scalp/pathology
- Scalp/surgery
- Skin Transplantation
- Surgical Flaps
- Survival Rate
- Tomography, X-Ray Computed
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Affiliation(s)
- Ricardo Santos de Oliveira
- Division of Pediatric Neurosurgery, Ribeirão Preto School of Medicine, University of São Paulo, Campus Universitário, 14049-900 Ribeirão Preto, Brazil.
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Tosun Z, Ozkan A, Savaci N. Is Surgery Always Necessary in the Treatment of Aplasia Cutis Congenita? Plast Reconstr Surg 2006; 117:1355-6. [PMID: 16582822 DOI: 10.1097/01.prs.0000205568.17410.7a] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bernbeck B, Schwabe J, Groninger A, Schaper J, Messing-Jünger H, Mayatepek E, Rosenbaum T. Aplasia cutis congenita of the scalp: how much therapy is necessary in large defects? Acta Paediatr 2005; 94:758-60. [PMID: 16188781 DOI: 10.1111/j.1651-2227.2005.tb01977.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To show that local antibiotic management and a regular inspection of aplasia cutis congenita of the skull can give an excellent result. METHOD This case reports a girl born with aplasia cutis congenita of the skull presenting with a large aplasia of the epidermis, dermis, subcutaneous tissue and galea, including a bone defect without any additional risk factor, e.g. early eschar formation, cerebrospinal fluid leakage or uncommon dural blood vessels. RESULTS A primarily conservative treatment with local wet and antibiotic dressings together with a systemic antibiotic treatment for the first 2 wk led to an excellent result and thus prevented untimely operative and peri-operative procedures. CONCLUSIONS Here we have shown that conservative treatment might be an option, even if the wound diameter is greater than 1 cm(2), to prevent infants from any untimely operative procedure with an elevated operative risk if any additional risk factors are excluded.
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Affiliation(s)
- B Bernbeck
- Children's Hospital, Heinrich Heine University Medical Centre, Düsseldorf, Germany.
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Henriques JGDB, Pianetti Filho G, Giannetti AV, Henriques KSW. Extensa falha cutânea e craniana em paciente com aplasia cutis congenita. ARQUIVOS DE NEURO-PSIQUIATRIA 2004; 62:1108-11. [PMID: 15608980 DOI: 10.1590/s0004-282x2004000600034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aplasia cutis congenita (ACC) é doença rara, caracterizada pela ausência de formação completa da pele. Geralmente ocorre no couro cabeludo, na linha mediana, e apresenta-se ao nascimento como uma ferida ulcerada que pode atingir diferentes profundidades e envolver o periósteo, crânio e dura-máter. Descrevemos o caso de menina recem-nascida que apresentava fácies dismórfica com defeito no couro cabeludo que abrangia a quase totalidade da abóbada craniana e apresentava falha óssea desde a base dos ossos frontais até os occipitais e mastóides. A dura-máter estava em sua maior parte exposta, sem sinais de fissuras. Devido à raridade da ACC e ao pequeno número de pacientes nas séries publicadas na literatura a padronização do tratamento ainda é incipiente. O que existem são recomendações. Ainda são necessários estudos que abordem desde a etiologia da doença até a avaliação dos métodos de tratamento e evolução de grupos maiores de pacientes.
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Saraiya HA. Management of aplasia cutis congenita of the scalp: a continuing enigma. BRITISH JOURNAL OF PLASTIC SURGERY 2002; 55:707-8. [PMID: 12550142 DOI: 10.1054/bjps.2002.3963] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
Aplasia cutis is one of the features of the Adams-Oliver syndrome, beside limb anomalies. Aplasia cutis, congenital absence of skin, is a lesion that usually presents over the vertex of the skull. Management of aplasia cutis depends on the size of the skin defect and the child's physical condition. Scalp defects larger than approximately 1 cm should be treated surgically. In patients with aplasia cutis, surgery should preferably be performed using rotation scalp flaps, and additional split skin grafts. The history of two babies with the Adams-Oliver syndrome is presented. In the Adams-Oliver syndrome, large rotation scalp flaps are not reliable due to the abnormal vascularity of the skin. Skin grafting is the safest way, preventing hemorrhage and infection, in the operative treatment of aplasia cutis in these babies.
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Affiliation(s)
- S J Beekmans
- Department of Plastic and Reconstructive Surgery at the Vrije Universiteit Medical Center, Amsterdam, the Netherlands.
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Koshy CE, Waterhouse N, Peterson D. Large scalp and skull defects in aplasia cutis congenita. BRITISH JOURNAL OF PLASTIC SURGERY 2001; 54:276-7. [PMID: 11254434 DOI: 10.1054/bjps.2001.3542] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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