Outcomes of Tissue Expander Application for Scalp Reconstruction in Extensive Aplasia Cutis Congenita

Skin Expander for Scalp Reconstruction: Reappraisal of a Reconstructive Procedure for Aplasia Cutis Congenita

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.

The Efficacy of Anterior Capsulotomy and Basal Capsulectomy Adherent to Expanded Scalp Flap During Alopecia Reconstruction in Pediatric Burned Patients

BACKGROUND

Scalp expansion is an optimal treatment for alopecia resulting from burn injuries, especially in the pediatric population through providing highly vascularized adjacent local tissues with optimal hair density, color matching, texture, and hair-bearing characteristics. The aim of this study was to evaluate the efficacy of anterior capsulotomy and basal capsulectomy adherent to expanded scalp flap during alopecia reconstruction with scalp expansion in pediatric burned patients.

METHODS

The study was conducted on 127 patients with an age range of 5 to 19 years who presented with postburn alopecia accompanied by hairline loss. The patients were divided into 2 groups: group I consisted of 58 patients who were operated on using conventional technique, and group II consisted of 69 patients who were operated using modified technique including basal capsulectomy on the skull side and anterior capsulotomy on the expanded scalp flap.

RESULTS

The Hairdex, a validated questionnaire of Hair-Specific Health-Related Quality of Life measures, showed that percentage of satisfaction concerning outcomes was 91.50%, psychological well-being was 95%, and self-confidence was 84.30% in group II, compared with 63%, 55.70%, and 66.20%, respectively, in group I. This significant values had a great positive effect on patient satisfaction, changing child's behavior and self-confidence.

CONCLUSION

Although physiological background of tissue expansion is the same, proper flap design with anterior capsulotomy on flap undersurface and basal capsulectomy on the skull side improve results of the traditional method significantly and minimize the complication rate. These surgical modifications provide maximum benefits from expanded tissue, with restoration of the hairline and a uniform hair direction.

LEVEL OF EVIDENCE

Level III, case-control study.

Isolated aplasia cutis congenita: A report of two cases

Congenital skin dysplasia, especially isolated scalp defects, is difficult to detect prenatally. The prognosis for isolated congenital scalp defects is good. Treatment options include conservative treatment and surgery. The choice of treatment depends on the patient's individual circumstances.

Multiple Aplasia Cutis Congenita Lesions of the Scalp: A Case Study

Aplasia cutis congenita (ACC) is a rare condition that presents at birth as an absence of skin that does not usually involve underlying structures. Occurring in 3/10,000 live births, ACC is evenly distributed between males and females; the risk of ACC increases to 7 percent in consanguineous marriages. Up to 86 percent of lesions are found on the scalp in the midline vertex position. Lesions can also be found on the trunk and limbs, as with Adams-Oliver syndrome or accompanying epidermolysis bullosa. ACC is associated with chromosomal abnormalities and 35-50 percent of the time with trisomy 13 (Patau syndrome). This case study presents an infant with multiple ACC lesions of the scalp. The pathophysiology, treatment, potential long-term complications, and nursing considerations are discussed.

A practical approach to the evaluation and treatment of an infant with aplasia cutis congenita

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.