Management of Aplasia Cutis Congenita of the Scalp

Abstract

At the WCH, we advocate adopting a conservative approach to management of ACC of the scalp. Defects can be successfully managed with a combination of regular dressings and systemic antibiotics. Regular wound monitoring is essential to detect any complications early to instigate appropriate treatment and determine the need for emergency surgical management.

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

“…The other option would have been surgical treatment and early definitive closure, as suggested in the literature. [17][18][19] Furthermore, in accordance with the present case, conservative treatment has been presented as the first choice for initial treatment [10][11][12][13]20 even for large defects of the scalp vertex (6 Â 4 cm, 8.5 Â 9 cm, and 8 Â 12 cm), involving both skin and calvarial bone. [21][22][23] Complications of conservative treatment (e.g., ruptured dura and exposure of the sagittal sinus, leakage of cerebrospinal fluid, and massive hemorrhage) 13 represent imperative indications for surgical intervention.…”

Our experience with a severe case of aplasia cutis congenita with a large skull defect

“…Surgical and conservative treatments have been advocated . Surgical treatment has been recommended only for very large defects (more than 2 cm in diameter) or those in which the underlying vascular or neural structures are exposed . Conservative management regimens are based on sound basic wound care principles and infection prevention using a variety of wound dressings and prophylactic antibiotics.…”

“…Conservative management regimens are based on sound basic wound care principles and infection prevention using a variety of wound dressings and prophylactic antibiotics. Acticoat, Omiderm, Xeroform, and Elasto‐Gel may decrease the need for frequent dressing changes, decrease inflammation and infection, minimize drying, and promote healing …”

First Case Report of an Infant with Aplasia Cutis Congenita of Scalp and Myelomeningocele

“…4 Conversely, cases with exposition of arachnoid, brain, and sagittal sinus, at high risk of meningitis or hemorrhage require surgical repair. 1,5 A significant number of these patients have concomitant congenital anomalies in the central nervous system (holoprosencephaly, hydrocephalus, myelomeningocele). 5 Many patients with myelomeningocele develop hydrocephalus (from 52% to 92%) and will undergo shunt placement.…”