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Kadivar M, Sangsari R, Rostamli S, Sotoudeh S, Mirnia K. Amniotic membrane dressings for treatment of aplasia cutis in newborns. Pediatr Dermatol 2024; 41:445-450. [PMID: 38409959 DOI: 10.1111/pde.15540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 01/13/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND Aplasia cutis congenita (ACC) is a rare congenital skin defect characterized by a focal or extensive absence of the epidermis, dermis, and occasionally, subcutaneous tissue. When the wound caused by this defect is wide or deep, various treatments are used, including skin grafting. The amniotic membrane (AM) is a biological dressing that facilitates re-epithelialization as it contains mesenchymal cells and numerous growth factors. OBJECTIVE To report the efficacy of AM dressings in treating the skin defects of ACC. METHOD This study was conducted on five neonates diagnosed with ACC born between 2018 and 2022, referred to the Children's Medical Center in Tehran, Iran. AM dressings were applied on wounds larger than 1 cm2. The wounds were assessed weekly and, if required, an additional AM dressing was applied. RESULTS The skin defects gradually re-epithelialized after application of the AM. The complete healing process took around 3.5 weeks on average. No hypertrophic scarring was observed. CONCLUSION The application of AM dressing resulted in satisfactory cosmetic outcomes, with no hypertrophic scar formation. Complete healing occurred in all cases except one. The length of the hospital stay ranged from 2 to 6 weeks, depending on the size of the wound.
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Affiliation(s)
- Maliheh Kadivar
- Department of Pediatrics, Division of Neonatology, School of Medicine, Tehran University of Medical Sciences, Children's Medical Center, Tehran, Iran
| | - Razieh Sangsari
- Department of Pediatrics, Division of Neonatology, School of Medicine, Tehran University of Medical Sciences, Children's Medical Center, Tehran, Iran
| | - Somayeh Rostamli
- Neonatal Intensive Care Nursing, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheila Sotoudeh
- Department of Dermatology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kayvan Mirnia
- Department of Pediatrics, Division of Neonatology, School of Medicine, Tehran University of Medical Sciences, Children's Medical Center, Tehran, Iran
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Cho HC, Hwang JH. Case of Mental Retardation Associated with Aplasia Cutis Congenita and Skull Defect. NEONATAL MEDICINE 2021. [DOI: 10.5385/nm.2021.28.1.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Kawaguchi N, Kuboi T, Yamato S, Okabe S, Nii K, Sadamura T, Nakano A, Morine M, Taniguchi H. Aplasia Cutis Congenita in an Infant with Very Low Birth Weight. J Pediatr 2020; 218:253-253.e1. [PMID: 31932018 DOI: 10.1016/j.jpeds.2019.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 11/18/2019] [Accepted: 11/20/2019] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | - Hidekazu Taniguchi
- Department of Child Neurosurgery, Shikoku Medical Center for Children and Adults, Kagawa, Japan
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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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Sahin C, Kaplan P, Ozturk S, Alpar S, Karagoz H. Treatment of partial-thickness burns with a tulle-gras dressing and a hydrophilic polyurethane membrane: a comparative study. J Wound Care 2019; 28:24-28. [PMID: 30625045 DOI: 10.12968/jowc.2019.28.1.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The purpose of this revisited study was to compare the clinical efficacy and long-term scar evaluation of a hydrophilic polyurethane membrane (HPM), Omiderm (Omikron Scientific Ltd., Rehovot, Israel) and an antimicrobial tulle-gras dressing (TGD), Bactigras (Smith & Nephew) in the management of partial-thickness burns. METHOD Patients with partial-thickness burns were enrolled in this prospective study. Burn areas were divided into two areas and both dressings were applied to each field at the same time. Time to full re-epithelialisation and scar evaluation were compared using the Vancouver Scar Scale (VSS). RESULTS A total of 21 patients, mean age 36.8 years, with 22 burns areas participated. The results showed that there is no statistically significant difference in terms of full epithelialisation time in the application of either dressing (p>0.05). However, with deep dermal burns, the HPM provided slightly faster epithelialisation (p>0.05). A VSS assessment showed no statistically significant difference (p>0.05) between applying either dressing materials. CONCLUSION This study indicated that both dressings had the same effectiveness in treatment of partial-thickness burn wounds. However, the use of the HPM, especially in deep dermal second-degree burns, should be one of the first-line clinical choices, based on the advantages discerned by this study.
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Affiliation(s)
- Cihan Sahin
- Associated Professor, Florence Nightingale Hospital, Department of Plastic, Reconstructive and Aesthetic Surgery, Atasehir/Istanbul, Turkey
| | - Pinar Kaplan
- Registered Nurse, Sultan Abdulhamid Han Training and Research Hospital, Burn Unit, Istanbul, Turkey
| | - Sinan Ozturk
- Plastic Surgeon, Private Practice, Corlu/Tekirdag, Turkey
| | - Sule Alpar
- Professor, Marmara University, Faculty of Health Sciences, Fundamentals of Nursing Department, Istanbul, Turkey
| | - Huseyin Karagoz
- Associate Professor, Wake Forest Institute for Regenerative Medicine (WFIRM), Wake Forest University, Winston-Salem, US
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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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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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Al-Hadithy N, Mennie J, Stewart K. Two different management modalities in a two sibling case report of Adams Oliver syndrome. BMJ Case Rep 2011; 2011:bcr.10.2011.4965. [PMID: 22670005 DOI: 10.1136/bcr.10.2011.4965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The authors report two-sibling case of Adams Oliver syndrome. One was managed with early surgical intervention after a period of failed conservative management and the other conservatively managed until reconstruction and surgical correction of alopecia. The goal of treatment is to achieve a complete closure of the defect without encountering any fatal complications such as haemorrhage and infection or causing any long-term neurological morbidity. Various papers have been published related to ACC, yet there is no consensus on the therapeutic approach. The management decision hinges upon balancing the risks of complications including spontaneous sagittal sinus haemorrhage and the risk of surgical intervention. Both treatment modalities proved successful in these cases.
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Affiliation(s)
- Nada Al-Hadithy
- Plastic Surgery Department, St John's Hospital, Livingston, UK.
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Khashab ME, Rhee ST, Pierce SD, Khashab YE, Nejat F, Fried A. Management of large scalp and skull defects in a severe case of Adams-Oliver syndrome. J Neurosurg Pediatr 2009; 4:523-7. [PMID: 19951037 DOI: 10.3171/2009.7.peds09220] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Adams-Oliver syndrome is a rare congenital disorder that includes congenital scalp and skull defects, variable degrees of terminal transverse limb anomalies, and cardiac malformations. Cutis aplasia occurring in 75% of patients is a potentially life-threatening condition. Large skin defects that cannot be closed primarily present a management dilemma, and may require skin grafting or flaps, or a combination of both operative and conservative modalities. The authors' experience in management of huge scalp and bone defects with the Integra Dermal Regeneration Template and regular dressing changes showed good scalp repair and no serious complications attributed to this approach.
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Affiliation(s)
- Mostafa El Khashab
- Department of Neurosurgery, Hackensack University Medical Center, Hackensack, NJ, USA
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Abstract
Aplasia cutis congenita is a rare congenital disorder of skin and most commonly involves the scalp. The skull and dura underlying the defective skin may also be affected, relative to severity of the disease. The typical lesion is present at birth and ranges in size from 0.5-3 cm. The main complications of larger defects include infection, bleeding and trombosis that may be deadly. Therefore, prompt diagnosis and appropriate treatment are critical for avoiding the adverse outcomes. Controversy exists in the literature regarding the treatment of aplasia cutis congenita; both surgical and conservative treatment modalities have their proponents and opponents. We present a case of full thickness aplasia cutis congenital lesion bigger than 3 cm in diameter that healed with the application of novel wound dressing materials without any complications. The physiopathology, classification and treatment options of the disease are discussed.
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Affiliation(s)
- Yavuz Başterzi
- Mersin University Faculty of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery, Mersin, Turkey.
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Canter HI. Comment on "An adherent dressing for aplasia cutis congenita". J Plast Reconstr Aesthet Surg 2006; 59:1469-70. [PMID: 17113546 DOI: 10.1016/j.bjps.2005.12.065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2005] [Accepted: 12/14/2005] [Indexed: 11/16/2022]
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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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