<b><i>Introduction:</i></b> 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. <b><i>Case Report:</i></b> 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. <b><i>Discussion:</i></b> 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.
Background
From early dynamic lines in smiling and squinting young people, crow's feet lines in the lateral canthal region evolve through prolonged tissue remodeling into mature, stable rhytids after the mid‐to‐late thirties, and requests for rejuvenating treatment. Because of the heterogeneous fanning behavior of crow's feet lines, individualizing neuromodulation with botulinum toxin injections might be a sound strategy to maximize aesthetic outcomes.
Aims
To investigate the prevalence of variable crow's feet line patterns at maximum contracture and while smiling and comment on the relative distribution of such patterns and the influence of aging. These considerations will be the basis and rationale for future studies that will individualize the total 24‐unit dose according to the distribution of crow's feet lines.
Methods
Identifying CFL orientation at maximum frown and while smiling; assessment tool: the four‐class 2015‐version of Kane's classification further modified by converting the former “central fan pattern” into a new, more precisely defined “extended full‐fan pattern” class.
Results
The 323 cohort subjects had a mean age of 51.5 ± 9.28 years. Although with some differences, outcomes in a central‐southern real‐world European Caucasian population appear similar to the distribution first studied in 2003 in a highly selected population in New England involved in double‐blind clinical trials. The full‐fan pattern predominated both at maximum contraction and when smiling, followed in prevalence by the upper‐fan pattern at maximum contraction and the extended full‐fan pattern while smiling. Age significantly influenced the crow's feet line pattern—lower‐fan patterns were more frequent than other patterns in the real‐world younger middle‐age group (40–49 years old); full‐fan and extended full‐fan patterns progressively more prevalent with aging.
Conclusions
The study confirms but somewhat modifies the previous evidence about the non‐homogeneous distribution of crow's feet line fanning patterns in different age groups and reinforces the case to individualize the topography of botulinum toxin injections.
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