Conservative Healing of an 11 × 9-cm Aplasia Cutis Congenita of the Scalp with Bone Defect

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.

Aplasia cutis congenita: Two case reports and discussion of the literature

“…[ 49 ] However, none of the more specialized dressing materials have proven to be significantly superior, and therefore, it is accepted to treat ACC with standard traditional wound care. [ 30 ] Although conservative treatment has traditionally been the default strategy for normal and small-sized lesions, lately there have been reports of extensive ACC lesions managed through the conservative route with excellent healing results,[ 14 37 ] and this shows a tendency of recent literature in favor of the conservative approach. In addition, there have been reports of even more specialized conservative treatment techniques such as the use of autologous cultured fibroblasts and keratinocytes[ 10 ] or the application of fibroblast growth factors that accelerate wound healing, a modality which might represent the future of ACC treatment drastically decreasing the number of surgically managed cases.…”

“…[ 41 ] In the near future, even more technologies are about to emerge to facilitate wound healing and wound closure, such as fibroblast growth factors and cultured skin, possibly even rendering surgical management obsolete. Throughout the literature, there are reports of extremely large defects treated conservatively with impressive results,[ 14 ] however, there are no reports of surgical management for lesions of size <30 cm 2 . [ 25 ] Present publications generally illustrate that conservative management is preferable, and surgical management is generally considered, but not always utilized, for lesions of size >30 cm 2 .…”

Failed conservative management of a case of aplasia cutis congenita in a low‐income country

“…Lacking even a plastic surgeon, conservative medical therapy was the only empirical treatment provided. Although contraindicated in newborns, we used silver sulfadiazine dressing as reported in several papers . Moreover, we administered systemic antibiotic therapy – another medication that is not appropriate in the management of large skin defects, mainly because it may cause the emergence of resistant bacteria – to prevent infection and sepsis.…”

Aplasia Cutis Congenita. Case report and literature review

“…Recently there are some cases of large lesions treated in conservative route with excellent results 28,33 . There have been reports of even more specialized conservative treatment techniques such as the use of autologous cultured fibroblast growth factors that accelerate wound healing, a modality which might represent the future of ACC treatment drastically decreasing the number of surgically managed cases 34 .…”