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Song Y, Yang R, Shi Z, Yan J, Hou S, Li X, Zhao X. Large skin defect in Type V aplasia cutis congenita treated with conservative treatment: a case report. BMC Pediatr 2024; 24:314. [PMID: 38714985 PMCID: PMC11075243 DOI: 10.1186/s12887-024-04777-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 04/19/2024] [Indexed: 05/12/2024] Open
Abstract
Aplasia cutis congenita (ACC) is a congenital disorder that can be classified into nine types, with Type I ACC being the most common. Type V ACC associated with fetus papyraceus is a rare subtype of ACC. We report the case of a Type V ACC in a male newborn with extensive abdominal skin defects. The patient received conservative treatment using hydrogel foam and silicone foam dressings. Approximately five weeks later, the patient was discharged when more than 60% of the skin had completed epithelialization. After discharge from West China Second University Hospital, Chengdu , the patient continued to be followed up regularly at the Burns and Plastic Surgery Clinic at local hospital in Gansu. We followed up the child by telephone. After 4 months of follow-up, scar tissue formation was observed in the trunk area. The infant is 2 years and 5 months old now, physical examination did not reveal any organ problems.
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Affiliation(s)
- Yan Song
- Department of Neonatology Nursing, West China Second University Hospital, Sichuan University, Chengdu, China
- Department of Nursing, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, (Sichuan University), Ministry of Education, Chengdu, China
| | - Ru Yang
- Department of Neonatology Nursing, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, (Sichuan University), Ministry of Education, Chengdu, China
| | - Zeyao Shi
- Department of Neonatology Nursing, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, (Sichuan University), Ministry of Education, Chengdu, China
| | - Jing Yan
- Department of Neonatology Nursing, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, (Sichuan University), Ministry of Education, Chengdu, China
| | - Shulin Hou
- Department of Neonatology Nursing, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, (Sichuan University), Ministry of Education, Chengdu, China
| | - Xiaowen Li
- Department of Neonatology Nursing, West China Second University Hospital, Sichuan University, Chengdu, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, (Sichuan University), Ministry of Education, Chengdu, China.
| | - Xiufang Zhao
- Department of Neonatology Nursing, West China Second University Hospital, Sichuan University, Chengdu, China.
- Department of Nursing, West China Second University Hospital, Sichuan University, Chengdu, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, (Sichuan University), Ministry of Education, Chengdu, China.
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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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Olubor OO, Hassim K, Graham-Evans K. Severe case of aplasia cutis congenita. Arch Dis Child Fetal Neonatal Ed 2024:fetalneonatal-2024-327067. [PMID: 38604652 DOI: 10.1136/archdischild-2024-327067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 04/02/2024] [Indexed: 04/13/2024]
Affiliation(s)
| | - Keira Hassim
- Neonatal Intensive Care Unit, Queen Alexandra Hospital, Portsmouth, UK
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Freedman JD, Gehring MB, O’Neill BR, French B, Khechoyan D. Repair of an Occipital Meningocele and Scalp Soft-tissue Reconstruction in a Newborn Patient. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5663. [PMID: 38463706 PMCID: PMC10923347 DOI: 10.1097/gox.0000000000005663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/19/2024] [Indexed: 03/12/2024]
Abstract
The differential diagnosis of large congenital scalp defects includes aplasia cutis and encephalocele, among others. Treatment includes conservative management with dressings or operative management with dermal substitutes, skin grafting, local flaps, and free flaps. This case report discusses the technical considerations and reconstructive strategies for repair of a meningocele in a newborn with a large 5.5-cm scalp defect. The key strategies include preemptive cerebrospinal fluid (CSF) diversion with external ventricular drain to reduce the risk of CSF leak and mitigate wound-healing complications; careful identification and avoidance of key anatomic structures, such as the superior sagittal sinus, as anatomy may be significantly distorted due to the presence of a meningocele and after CSF diversion; and careful, thoughtful design of the local scalp flaps to maximize blood supply and to avoid tension on the final reconstruction.
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Affiliation(s)
- Jonathan D. Freedman
- From the Division of Plastic Surgery, Department of Surgery, University of Colorado, Aurora, Colo
| | - Michael B. Gehring
- From the Division of Plastic Surgery, Department of Surgery, University of Colorado, Aurora, Colo
| | | | - Brooke French
- From the Division of Plastic Surgery, Department of Surgery, University of Colorado, Aurora, Colo
| | - David Khechoyan
- From the Division of Plastic Surgery, Department of Surgery, University of Colorado, Aurora, Colo
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5
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Arcuri F, Ardito E, Bianchi B. Skin Expander for Scalp Reconstruction: Reappraisal of a Reconstructive Procedure for Aplasia Cutis Congenita. J Craniofac Surg 2024:00001665-990000000-01386. [PMID: 38421169 DOI: 10.1097/scs.0000000000010053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 01/08/2024] [Indexed: 03/02/2024] Open
Abstract
PURPOSE Aplasia cutis congenita (ACC) is a heterogeneous group of congenital disorders characterized by the absence of epidermis, dermis, appendages, subcutaneous tissue, and bone. The aim of the study is to describe a clinical report of ACC of the scalp treated with skin expanders. CLINICAL REPORT In October 2019, a 16-year-old female patient underwent scalp expansion with 2 rectangular devices (150 and 250 cm3; Radovan Mentor-Johnson&Johnson). The inflation started 30 days after surgery and continued once every 7 to 10 days to gain 10% of overexpansion. After 3 months, the patient underwent the second surgical step with the expanded scalp transposed to close the defect. Clinical examination 6 months after surgery revealed an acceptable cosmetic result with a hidden surgical scar and hair growth in the previous area of frontoparietal alopecia. CONCLUSION Skin expander for the reconstruction of extensive ACC defects of the scalp is a valid procedure.
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Zhang Y, Ning J. Nursing care of a rare case of congenital bullosa cutis hypoplasia. Asian J Surg 2023; 46:6031-6032. [PMID: 37723028 DOI: 10.1016/j.asjsur.2023.09.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/06/2023] [Indexed: 09/20/2023] Open
Affiliation(s)
- Yan Zhang
- Department of Pediatrics, Maternal and Child Health Hospital of Fushun County, Sichuan Province, Fushun, 643200, China
| | - Junjie Ning
- Department of Pediatrics, First People's Hospital of Zigong City, Sichuan Province, Zigong, 643000, China.
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Chang-Azancot L, Campello M, Montón J. Conservative Management of a Rare Entity-Aplasia Cutis Congenita: A Case Report. PLASTIC AND AESTHETIC NURSING 2023; 43:149-153. [PMID: 37389632 DOI: 10.1097/psn.0000000000000511] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Aplasia cutis congenita (ACC) is a rare entity characterized by a congenital localized absence of the skin, dermal appendages, and subcutaneous tissue. The cause of ACC is not clear, but inheritance is the most widely accepted cause. We report a rare case of a full-term (37 + 5 weeks) female newborn who showed complete absence of skin in localized areas of the upper and lower extremities. The patient was diagnosed with ACC associated with epidermolysis bullosa (EB; a disease that causes the skin to blister easily) and was initially treated using conservative measures. We applied mupirocin topical ointment and a nonocclusive polyester mesh impregnated with hydrocolloid and petroleum jelly daily. Complete healing of the affected areas occurred after 3 weeks. Managing patients with ACC is often challenging and based on the severity of the lesions, the approach may include both surgical and conservative treatment. Our case report suggests that a conservative approach can be effective for managing certain types of ACC and EB lesions. However, further research is warranted to better understand the pathogenesis and optimal management of this entity.
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Affiliation(s)
- Luis Chang-Azancot
- Luis Chang-Azancot, MD, is a resident at the Plastic Surgery Department, Albacete University Hospital, Spain
- Manuel Campello, MD, is a resident at the Plastic Surgery Department, Albacete University Hospital, Spain
- Javier Montón, MD, PhD, is the head of the Plastic Surgery Department, Albacete University Hospital, Spain. Dr. Montón is also an associate professor, Anatomy and Embryology Unit, Faculty of Medicine, University of Castilla-La Mancha (UCLM), Albacete, Spain
| | - Manuel Campello
- Luis Chang-Azancot, MD, is a resident at the Plastic Surgery Department, Albacete University Hospital, Spain
- Manuel Campello, MD, is a resident at the Plastic Surgery Department, Albacete University Hospital, Spain
- Javier Montón, MD, PhD, is the head of the Plastic Surgery Department, Albacete University Hospital, Spain. Dr. Montón is also an associate professor, Anatomy and Embryology Unit, Faculty of Medicine, University of Castilla-La Mancha (UCLM), Albacete, Spain
| | - Javier Montón
- Luis Chang-Azancot, MD, is a resident at the Plastic Surgery Department, Albacete University Hospital, Spain
- Manuel Campello, MD, is a resident at the Plastic Surgery Department, Albacete University Hospital, Spain
- Javier Montón, MD, PhD, is the head of the Plastic Surgery Department, Albacete University Hospital, Spain. Dr. Montón is also an associate professor, Anatomy and Embryology Unit, Faculty of Medicine, University of Castilla-La Mancha (UCLM), Albacete, Spain
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8
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Hui CL, Ang DS, Ngeow AJ, Ong YS. “A Rare Case of Extensive Aplasia Cutis Congenita: our surgical approach”. J Plast Reconstr Aesthet Surg 2023; 80:193-199. [PMID: 37068346 DOI: 10.1016/j.bjps.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/06/2022] [Accepted: 02/13/2023] [Indexed: 02/18/2023]
Abstract
Aplasia cutis congenita (ACC) is a rare disorder resulting in the absence of skin or deeper layers, most often involving an isolated small area on the scalp. However, extensive cutis aplasia involving multiple large critical areas of the body is extremely uncommon and remains a challenging condition to manage. Initial concerns involve early mortality from excessive moisture loss, hypothermia, bleeding, sepsis, and brain herniation while subsequent sequelae from delayed wound healing resulting in scarring and loss of function also provide numerous management dilemmas. Conservative treatment with dressings, which typically allows epithelisation in small cases, is inadequate. Surgical approaches described such as skin grafts and rotational flaps are also insufficient in extensive ACC involving the chest and entire scalp. In this article, we present how our centre successfully treated a patient with a large total body surface area of ACC involving the entire scalp, neck, forehead, chest, trunk, lateral flanks, and patchy areas of all four limbs.
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Muacevic A, Adler JR, Alallah B, Alallah J. Aplasia Cutis Congenita of the Lower Limb: A Case Report. Cureus 2023; 15:e33376. [PMID: 36751246 PMCID: PMC9898798 DOI: 10.7759/cureus.33376] [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: 01/04/2023] [Indexed: 01/06/2023] Open
Abstract
Aplasia cutis congenita type VI is a genetic disorder that presents with congenital skin absence, blistering, and nail abnormalities. We present the case of a male newborn who presented with an absence of skin in the entire left leg and the lower part of the left thigh. On the second day of life, he had new skin lesions that started to appear over the fingernail beds, nasal bridge, thighs, and buttocks. There were no other associated anomalies such as pyloric atresia, renal abnormalities, or ureteral stenosis. A diagnosis of Bart's syndrome was made based on clinical diagnosis and previous presentation in the family. The patient developed sepsis and osteomyelitis of the lower limb and eventually died.
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10
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Quak SM, Chong SY. Case Report: Anesthesia for a Neonate With Cutis Aplasia. A A Pract 2022; 16:e01628. [PMID: 36599036 DOI: 10.1213/xaa.0000000000001628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Cutis aplasia is a rare condition characterized by skin and subcutaneous tissue defects. Researchers have previously described both conservative and surgical management methods. We report herein the case of a neonate with extensive cutis aplasia involving 37% of the total body surface area. Due to the risk of meningitis and catastrophic hemorrhage associated with scalp defects, she underwent staged surgical procedures with skin harvesting and synthetic skin application, followed by the application of cultured epithelial autografts. This report highlights the challenges in temperature and fluid management as well as intraoperative positioning in a neonate with cutis aplasia.
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Affiliation(s)
- Su Min Quak
- From the Department of Anesthesiology, Singapore General Hospital, Singapore
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11
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Garcia C, Wortsman X, Bazaes-Nuñez D, Pelizzari M, Gonzalez S, Cossio ML, De Barbieri F. Skin sonography in children: a review. Pediatr Radiol 2022; 52:1687-1705. [PMID: 35821441 DOI: 10.1007/s00247-022-05434-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/29/2022] [Accepted: 06/15/2022] [Indexed: 11/30/2022]
Abstract
Skin lesions are not uncommon in children, and most of them are benign. However, they can be a matter of concern. Although in most cases the diagnosis can be suspected based on clinical history and physical examination, in some cases clinical findings are nonspecific. High-frequency color Doppler US is a noninvasive technique that can play a relevant role in these cases and give important anatomical information for final clinical management. US can be helpful to avoid unnecessary surgery, plan a surgical excision and avoid advanced imaging studies such as MRI and CT, which have a lower resolution for the skin. Different lesions can look similar on US, and clinical correlation is always important. The purpose of this article is to show a variety of skin lesions that occur in children, emphasizing clinical-sonographic correlation, and to familiarize pediatric radiologists with the US technique and sonographic appearance of common skin lesions in children.
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Affiliation(s)
- Cristian Garcia
- Department of Radiology, Pontificia Universidad Católica de Chile, 367 Marcoleta, 8330024, Santiago, Chile.
| | - Ximena Wortsman
- Department of Dermatology, Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Diego Bazaes-Nuñez
- Department of Radiology, Pontificia Universidad Católica de Chile, 367 Marcoleta, 8330024, Santiago, Chile
| | - Mario Pelizzari
- Department of Radiology, Universidad Católica de Córdoba, Ciudad de Córdoba, República Argentina.,Section of Pediatric Radiology, Instituto Oulton, Ciudad de Córdoba, República Argentina
| | - Sergio Gonzalez
- Department of Pathology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Maria-Laura Cossio
- Department of Dermatology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Florencia De Barbieri
- Department of Radiology, Pontificia Universidad Católica de Chile, 367 Marcoleta, 8330024, Santiago, Chile
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Abstract
Bart’s syndrome is a combination of the following three criteria: congenital skin absence, blistering, and associated nail defects. We present a rare case of twins with Bart’s syndrome, who were born with congenital absence of skin and developed blisters on the skin and mucous membrane on the following days. Twins are identically affected, which confirms the genetic basis of the syndrome.
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13
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McKenzie PL, Castelo-Soccio L. Localized hair loss in infancy: a review. Curr Opin Pediatr 2021; 33:416-422. [PMID: 34016809 DOI: 10.1097/mop.0000000000001025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The current review will address the different causes of localized hair loss in infancy. The data presented here will provide clinicians with the latest understanding of different disorders leading to localized hair loss and will provide recommendations for further management of infants who present with alopecia. RECENT FINDINGS Localized hair loss in infancy is common, but its underlying causes vary greatly. Alopecia in infants can be categorized into congenital, genetic, inflammatory, mechanical, and physiologic causes. Decisions regarding further management are complex, as they often involve not only cosmetic concerns, but also work-up of possible systemic medical issues related to hair loss. SUMMARY Clinicians must be able to distinguish between the different causes of infantile hair loss so that appropriate work-up and further management can be pursued. Factors such as physical appearance, timing of presentation, dermoscopic exam, histopathology, and associated systemic features can help lead clinicians to the correct diagnosis in the case of an infant with localized alopecia.
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Affiliation(s)
- Paige L McKenzie
- Section of Dermatology, Division of Pediatrics, The Children's Hospital of Philadelphia
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Leslie Castelo-Soccio
- Section of Dermatology, Division of Pediatrics, The Children's Hospital of Philadelphia
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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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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Kuemmet TJ, Miller JJ, Michalik D, Lew SM, Maheshwari M, Humphrey SR. Low risk of clinically important central nervous system dysraphism in a cohort study of 69 patients with isolated aplasia cutis congenita of the head. Pediatr Dermatol 2020; 37:455-460. [PMID: 32053222 DOI: 10.1111/pde.14117] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Aplasia cutis congenita of the head may be associated with underlying fusion defects in the skin, soft tissues, muscle, or bone. The risk of central nervous system dysraphism in patients with aplasia cutis congenita is not known; however, knowledge of underlying structural defects can inform management considerations. METHODS This retrospective review investigated the risk of cranial central nervous system dysraphism in children presenting with aplasia cutis congenita of the head, who presented between 1/1/2000 and 6/15/2016. Inclusion criteria were subjects with aplasia cutis congenita of the head who received CT or MR imaging of the head. RESULTS We identified a total of 69 subjects with aplasia cutis congenita affecting the head and who received imaging. The most common location of the aplasia cutis congenita lesion was the vertex scalp (49.3%). The hair collar sign was present in 27.5% of patients. Twelve of 69 patients (17.4%) demonstrated abnormalities of the bone, vasculature, or brain on head imaging. Only one patient had a diagnosis of encephalocele that required neurosurgical intervention. There was a statistical association between the hair collar sign and the presence of abnormal imaging findings (P = .029), with a negative predictive value of 89.4%. CONCLUSIONS The incidence of central nervous system dysraphism in patients with aplasia cutis congenita of the head appears to be low, and it may not be necessary to image the head of each child presenting with this skin lesion. The hair collar sign may be a marker of underlying defects.
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Affiliation(s)
- Travis J Kuemmet
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - James J Miller
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Daniel Michalik
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | - Sean M Lew
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mohit Maheshwari
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Stephen R Humphrey
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
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16
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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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17
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Koumaki D, Koumaki V, Boumpoucheropoulos S, Baltaga L, Bitados P, Katoulis A, Krasagakis K. Newborn with a solitary hairless skin defect on the scalp vertex. Clin Case Rep 2019; 7:2281-2282. [PMID: 31788305 PMCID: PMC6878089 DOI: 10.1002/ccr3.2468] [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] [Received: 08/08/2019] [Revised: 09/09/2019] [Accepted: 09/11/2019] [Indexed: 11/22/2022] Open
Abstract
Aplasia cutis congenita is a rare congenital disorder usually presenting as an isolated lesion on the scalp that may be associated with genetic syndromes and congenital anomalies. Therefore, it is important to be aware of this syndrome.
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Affiliation(s)
- Dimitra Koumaki
- Paediatric Dermatology DepartmentChelsea and Westminster Foundation TRUSTLondonUK
| | - Vasiliki Koumaki
- Department of MicrobiologyMedical School University of AthensAthensGreece
| | | | | | | | - Alexander Katoulis
- 2nd Department of Dermatology and VenereologyNational and Kapodistrian University of Athens, Medical School, “Attikon” General University HospitalAthensGreece
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18
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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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A practical approach to the evaluation and treatment of an infant with aplasia cutis congenita. J Perinatol 2018; 38:110-117. [PMID: 29048413 DOI: 10.1038/jp.2017.142] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 07/12/2017] [Accepted: 08/03/2017] [Indexed: 12/26/2022]
Abstract
Aplasia cutis congenita (ACC) is a term describing absence of skin at birth. ACC is a rare cutaneous finding, often noted with no other physical abnormalities. The etiology of ACC varies, and there are likely several causes for its development. ACC can be located anywhere on the body. Its clinical appearance and location can alert the clinician to other potential abnormalities and associations. This discussion covers the diagnosis of ACC and its subtypes and associations in order to provide a pragmatic, clinically relevant and patient-centered approach to evaluation and treatment.
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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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Shrager S, Voin V, Iwanaga J, Tubbs RS, Johnston J. Extreme aplasia cutis congenita involving the skull. Childs Nerv Syst 2017; 33:1395-1398. [PMID: 28477039 DOI: 10.1007/s00381-017-3426-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 04/19/2017] [Indexed: 10/19/2022]
Abstract
Aplasia cutis congenita (ACC) is a rare congenital malformation of primarily the skin; it is most commonly seen on the scalp but can occur anywhere on the body. The exact etiology is still unclear but there are many suggested causes. Classification systems have been proposed to help categorize patients and assist with treatment. Treatment options are controversial and range from conservative to surgical interventions. We report an extreme case of ACC that included a significant part of the skull. We discuss this case and review salient literature. Although such cases of ACC with bony involvement are rare, this aspect of the pathology should be kept in mind when treating or imaging such patients.
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Affiliation(s)
- Sebastian Shrager
- Department of Anatomical Sciences, St. George's University, St. George, Grenada
| | - Vlad Voin
- Seattle Science Foundation, 550 17th Ave, James Tower, Suite 600, Seattle, WA, 98122, USA.
| | - Joe Iwanaga
- Seattle Science Foundation, 550 17th Ave, James Tower, Suite 600, Seattle, WA, 98122, USA
| | - R Shane Tubbs
- Department of Anatomical Sciences, St. George's University, St. George, Grenada.,Seattle Science Foundation, 550 17th Ave, James Tower, Suite 600, Seattle, WA, 98122, USA
| | - James Johnston
- Pediatric Neurosurgery, Children's of Alabama, Birmingham, AL, USA
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Cherubino M, Maggiulli F, Dibartolo R, Valdatta L. Treatment of multiple wounds of aplasia cutis congenita on the lower limb: a case report. J Wound Care 2017; 25:760-762. [PMID: 27974014 DOI: 10.12968/jowc.2016.25.12.760] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Aplasia cutis congenita (ACC) is a rare congenital disease, characterised by absence of skin, that can affect different parts of the body. ACC is more frequent on the scalp, but can involve limbs, with partial-or total-thickness loss of skin, with a functional impairment of the joint affected. There is no clear indication for surgical or conservative treatment, therefore, it would be helpful to find scientific support for the optimal treatment strategies. CLINICAL PRESENTATION We present a case of a newborn female, with six wounds on the inferior limbs, treated with conservative therapy. To prevent infection and promote healing, the defects were kept moist and covered with non-adherent/antimicrobical dressings. Complete wound healing occurred in eight weeks. The duration of follow-up was three years. RESULTS In this kind of ACC with superficial partial-thickness wounds of the lower limbs, conservative treatment was successful. The same conservative treatment can be proposed for larger or deeper wounds of lower limbs with no involvement of underlying structures, with delayed scar excision after the complete growth of the patient. ACC scar excision could require complex tissue rearrangement, tissue expansion, or skin grafting. CONCLUSION In the evaluation for treatment of ACC of inferior limbs, even in cases of total-thickness skin loss, even on joints, the conservative approach could be considered as the first choice. DECLARATION OF INTEREST None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript.
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Affiliation(s)
- M Cherubino
- Plastic and Reconstructive Unit, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.,University of Insubria, Varese Italy
| | - F Maggiulli
- Plastic and Reconstructive Unit, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - R Dibartolo
- Plastic and Reconstructive Unit, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - L Valdatta
- Plastic and Reconstructive Unit, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.,University of Insubria, Varese Italy
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Muñoz-Guerrero F, Muñoz-Solís AA, Ornelas-Aguirre JM. [Aplasia cutis congenita associated with epidermolysis bullosa]. CIR CIR 2016; 85 Suppl 1:76-79. [PMID: 27979363 DOI: 10.1016/j.circir.2016.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 09/10/2016] [Accepted: 10/17/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Aplasia cutis congenita (ACC) is a skin condition of rare presentation, this disease is characterized by absence of skin at birth and associated with facial, skin and bone skull deformities. The diagnosis is mainly clinical. CASE REPORT Male 5 days after birth, unique product of primigravida mother and no family history of relevance. Physical examination revealed bilateral and symmetrical skin defects of both lower extremities, the disease is characterized by skin fragility, scabs, and coated pseudomembrane ulcers, decreased interdigital space between toes of the left foot, retraction of the foot and genu varum. It was handled with allograft of epidermis cultured in vitro, general wound care and clinical follow-up. DISCUSSION ACC associated with epidermolysis bullosa is one of the rarer forms of presentation. It is necessary to rule out other skin diseases. Clinical management is recommended with biological or synthetic skin cover, infection prevention, early treatment of complications and clinical follow.
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Affiliation(s)
- Félix Muñoz-Guerrero
- Unidad Médica de Alta Especialidad, Unidad de Quemados, Hospital de Especialidades No. 2, Instituto Mexicano del Seguro Social, Ciudad Obregón, Sonora, México.
| | - Adrián Antonio Muñoz-Solís
- Servicio de Urgencias Médicas, Hospital General de Zona No. 30, Instituto Mexicano del Seguro Social, Mexicali, Baja California, México
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Hioki T, Takama H, Makita S, Akiyama M. Infant bald patch: ultrasonographic diagnosis of aplasia cutis congenita. J Eur Acad Dermatol Venereol 2016; 31:e276-e277. [DOI: 10.1111/jdv.14018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- T. Hioki
- Department of Dermatology; Gifu Prefectural Tajimi Hospital; Gifu Japan
| | - H. Takama
- Department of Dermatology; Aichi Medical University; Aichi Japan
- Department of Dermatology; Nagoya University Graduate School of Medicine; Aichi Japan
| | - S. Makita
- Department of Dermatology; Gifu Prefectural Tajimi Hospital; Gifu Japan
| | - M. Akiyama
- Department of Dermatology; Nagoya University Graduate School of Medicine; Aichi Japan
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Belkhou A, François C, Bennis Y, Duquennoy-Martinot V, Guerreschi P. Aplasia cutis congenita : mise au point et prise en charge. ANN CHIR PLAST ESTH 2016; 61:450-461. [DOI: 10.1016/j.anplas.2016.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 07/04/2016] [Indexed: 10/21/2022]
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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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Koksal V, Kayaci S, Bedir R. Split Rib Cranioplasty for Frontal Osteoma: A Case Report and Review of the Literature. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e29541. [PMID: 27656291 PMCID: PMC5026782 DOI: 10.5812/ircmj.29541] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/02/2015] [Accepted: 07/11/2015] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Osteomas are benign bone tumors. They generally lead to a local thickness on the frontal bone in calvarium. When they occur on the forehead, they often cause a cosmetic disorder without any neurological symptoms. The significant problem is the repair method of the cranium defect. CASE PRESENTATION The rib of a 34-year-old female was split and used for a small cranium defect of 3 × 3.5 cm. The preferred method and the obtained results were presented under the guidance of the literature. CONCLUSIONS Along with the technological advancement, different materials are employed according to the size of the cranium defect and the age of the case. The application of split costa cranioplasty for the small cranium defects in the region of patient's face is the method with the least possibility of complications, and its cosmetic and functional results are quite promising.
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Affiliation(s)
- Vaner Koksal
- Department of Neurosurgery, Medical School, Recep Tayip Erdogan University, Rize, Turkey
- Corresponding Author: Vaner Koksal, Department of Neurosurgery, Medical School, Recep Tayip Erdogan University, Rize, Turkey. Tel: +90-5055212361, Fax: +90-4642123015, E-mail:
| | - Selim Kayaci
- Department of Neurosurgery, Medical School, Recep Tayip Erdogan University, Rize, Turkey
| | - Recep Bedir
- Department of Pathology, Medical School, Recep Tayip Erdogan University, Rize, 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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Type VI Aplasia Cutis Congenita: Bart's Syndrome. Case Rep Dermatol Med 2015; 2015:549825. [PMID: 26609453 PMCID: PMC4644546 DOI: 10.1155/2015/549825] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 10/17/2015] [Accepted: 10/18/2015] [Indexed: 11/17/2022] Open
Abstract
Bart's syndrome is characterized by aplasia cutis congenita and epidermolysis bullosa. We present the case of a newborn male who developed blisters on the mucous membranes and the skin following congenital localized absence of skin. Bart's syndrome (BS) is diagnosed clinically based on the disorder's unique signs and symptoms but histologic evaluation of the skin can help to confirm the final diagnosis. The patient was managed conservatively with topical antibacterial ointment and wet gauze dressing. Periodic follow-up examinations showed complete healing. We emphasized that it is important to use relatively simple methods for optimal healing without the need for complex surgical interventions.
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Calvarial Regeneration With Use of Acellular Dermal Matrix in Aplasia Cutis Congenita. J Craniofac Surg 2015; 26:1960-2. [DOI: 10.1097/scs.0000000000002024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Puvabanditsin S, February M, Garrow E, Bruno C, Mehta R. Our experience with a severe case of aplasia cutis congenita with a large skull defect. Int J Dermatol 2015; 55:1151-3. [PMID: 26228315 DOI: 10.1111/ijd.13008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 02/13/2015] [Indexed: 11/27/2022]
Affiliation(s)
| | - Melissa February
- Department of Pediatrics, Rutgers RWJ Medical School, New Brunswick, NJ, USA
| | - Eugene Garrow
- Department of Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Chantal Bruno
- Department of Pediatrics, Rutgers RWJ Medical School, New Brunswick, NJ, USA
| | - Rajeev Mehta
- Department of Pediatrics, Rutgers RWJ Medical School, New Brunswick, NJ, USA
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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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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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Zimmerman B, Chamlin SL. A 6-week-old girl with a scalp lesion. Pediatr Ann 2013; 42:13-5. [PMID: 23316827 DOI: 10.3928/00904481-20121221-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CME EDUCATIONAL OBJECTIVES: 1.Identify the clinical features of aplasia cutis congenita (ACC).2.Understand the differential diagnosis of ACC.3.Recognize features of concern for underlying associations of ACC. A 6-week-old girl presented to the dermatology clinic for evaluation of a scalp lesion. She was born full-term by vaginal delivery to a 27-year-old healthy mother with normal prenatal labs. The delivery was complicated by prolonged rupture of membranes and a scalp electrode was placed at hour 20 of labor. Forceps or other instrumentation were not used during delivery. In the general care nursery, the infant was noted to have a scalp lesion. No bleeding or drainage was ever noted from the area. The lesion remained unchanged since birth with no intermittent enlargement noted. Review of systems was unremarkable. Family history was noncontributory.
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Affiliation(s)
- Bree Zimmerman
- Department of Pediatrics, Rush University Medical Center, Chicago, IL 60611, USA
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Levine SM, Reformat DD, Thorne CH. Cutis aplasia: perioperative management and case report. Am J Crit Care 2012; 21:212-5. [PMID: 22549580 DOI: 10.4037/ajcc2012904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Aplasia cutis congenita, a rare congenital disorder involving defects of some or all of the layers of the cranium, is associated with potential life-threatening complications. Although treatment involves both nonsurgical and surgical techniques, the importance of perioperative management cannot be overstressed. A multidisciplinary team, including personnel from nursing, neonatology, pediatrics, radiology, neurosurgery, and plastic surgery services, diagnosed aplasia cutis congenita and planned local wound care, surgical correction, and prevention of potentially life-threatening complications in a 1-day-old boy with a 6×5-cm full-thickness scalp defect.
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Affiliation(s)
- Steven M. Levine
- Steven M. Levine is a chief resident, Derek D. Reformat is a resident, and Charles H. Thorne is an associate professor of plastic surgery at the Institute of Reconstructive Plastic Surgery, New York University Langone Medical Center, New York, New York
| | - Derek D. Reformat
- Steven M. Levine is a chief resident, Derek D. Reformat is a resident, and Charles H. Thorne is an associate professor of plastic surgery at the Institute of Reconstructive Plastic Surgery, New York University Langone Medical Center, New York, New York
| | - Charles H. Thorne
- Steven M. Levine is a chief resident, Derek D. Reformat is a resident, and Charles H. Thorne is an associate professor of plastic surgery at the Institute of Reconstructive Plastic Surgery, New York University Langone Medical Center, New York, New York
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