Conservative Management of Aplasia Cutis Congenita

Aplasia Cutis Congenita of the Scalp, Composite Type: The Criticality and Inseparability of Neurosurgical and Plastic Surgical Management

“…Complete closure of large full-thickness defects of the scalp and bone in response to local wound care has been reported, but the process can take months or years, leaving the patient at continual risk for complications until the wound is closed [2,5,45,59,65,66]. Importantly, there are reports of nonsurgical management of aplasia cutis congenita being quickly abandoned in response to near-fatal hemorrhages [36,58].…”

“…Nonsurgical regimens reported for the management of aplasia cutis congenita, with varying degrees of success, have included the following: gauze dressings with continuous saline drips [33], adherent dressings [67], nonadherent dressings [68], bacitracin ointment [65], povidone-iodine [24], and Silvadene® (silver sulfadiazine) [18,29,37,45]. Silvadene is contraindicated in newborns under 2 months of age and should not be used in children with very large composite defects of the scalp [69].…”

Scalp Aplasia Cutis Congenita Presenting With Sagittal Sinus Hemorrhage

“…7,14 The use of antiseptic or antibiotic ointment and wet dressings has frequently been advocated for treatment of the open wound. 3,7,13,14 In contrast, Abbott et al 15 favor early surgical intervention to obtain definitive coverage of defects and to prevent infection or life-threatening hemorrhage. Ross et al 7 advocate a more selective approach, by which large defects are closed early and small defects are treated conservatively, unless a complication necessitates surgical intervention.…”

“…2 Larger lesions, however, particularly those over a fontanel, are at risk for lethal hemorrhage. 3 If the dura is exposed, risk of meningitis is an additional concern. Surgeons managing these cases need to be able to recognize the lesion and to be aware of its genetic transmission, associated anomalies, potential complications, and different management options.…”

Aplasia cutis congenita of the Scalp: Issues in Its Management

“…In over 30% of these cases the defect can extend through the calvarium with exposure of the dura resulting [1], Most reports have stressed the importance of not allow ing an eschar to form on the exposed dura, for in this circumstance there is a high risk for infection or lifethreatening hemorrhage from a laceration to the sagittal sinus [2][3][4][5], To avoid this either early skin coverage of the defect or frequent moist dressings have been advo cated [2, 4. 6], In this paper, we add two more case of ACC of the scalp to the literature to stress the impor tance of avoidance of eschar formation over the sagittal sinus and to highlight the advantage of definitive cover age of these defects with skin.…”