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Elrod J, Fattouh M, Hagemann C, Königs I. Encephalocele as a rare complication of conservatively managed cranial aplasia cutis in a boy with Adams-Oliver syndrome. Pediatr Neonatol 2024; 65:312-313. [PMID: 38429208 DOI: 10.1016/j.pedneo.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/30/2023] [Accepted: 10/02/2023] [Indexed: 03/03/2024] Open
Affiliation(s)
- Julia Elrod
- Department of Pediatric Surgery, University Medical Centre Eppendorf, Hamburg, Germany; Department of Pediatric Surgery, University Medical Centre Mannheim, Mannheim, Germany
| | - Miriam Fattouh
- Department of Pediatric Surgery, University Medical Centre Eppendorf, Hamburg, Germany; Department of Paediatric Surgery, Burn Unit, Plastic and Reconstructive Surgery, Altona Children's Hospital, Hamburg, Germany
| | - Christian Hagemann
- Department of Paediatric Neurosurgery, Altona Children's Hospital, Hamburg, Germany
| | - Ingo Königs
- Department of Pediatric Surgery, University Medical Centre Eppendorf, Hamburg, Germany; Department of Paediatric Surgery, Burn Unit, Plastic and Reconstructive Surgery, Altona Children's Hospital, Hamburg, Germany.
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Arcuri F, Ardito E, Bianchi B. Skin Expander for Scalp Reconstruction: Reappraisal of a Reconstructive Procedure for Aplasia Cutis Congenita. J Craniofac Surg 2024:00001665-990000000-01386. [PMID: 38421169 DOI: 10.1097/scs.0000000000010053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 01/08/2024] [Indexed: 03/02/2024] Open
Abstract
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.
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Karakawa R, Yano T, Yoshimatsu H, Koto M, Nakao A, Ichi S. Use of Ultra-high-frequency Ultrasound for Aplasia Cutis Congenita of the Scalp. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3876. [PMID: 34815916 PMCID: PMC8604012 DOI: 10.1097/gox.0000000000003876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/24/2021] [Indexed: 11/25/2022]
Abstract
Aplasia Cutis Congenita (ACC) in the scalp is a rare congenital malformation. The treatment for ACC with large defects involving the scalp, bone, and the dura is challenging. Local debridement of necrotic tissue is important to prevent lethal complications such as infection and meningitis. However, debridement has the risk of damaging the sagittal sinus or the dura. Recent developments in ultra-high-frequency ultrasound(US) systems provide frequencies of 70 MHz and capability resolution as fine as 30 μm, which could allow precise imaging of small and thin anatomical structures. The study aimed to describe the methods of precise evaluation of the defect in the scalp and safe debridement using ultra-high-frequency US. This is the first report on direct observation of a newborn’s brain using ultra-high-frequency US. The boy was delivered spontaneously with a large defect of the scalp and bone. After 14 days, due to signs of infection, local debridement was performed carefully under ultra-high-frequency US-based evaluation. The dura, the sagittal sinus, and the small anatomical structures such as arachnoid granulations could be observed. Because the brain herniation gradually aggravated, dural reconstruction using fascia lata and scalp reconstruction using transposition flap was performed. Finally, good skin coverage over the defects was obtained. This method minimizes the risk of damaging the sagittal sinus and the brain parenchyma, which may cause fatal complications. Although further clinical investigations will be required to confirm its efficacy, ultra-high-frequency US has the potential to be a useful device for ACC treatment.
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Affiliation(s)
- Ryo Karakawa
- Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tomoyuki Yano
- Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hidehiko Yoshimatsu
- Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Mayu Koto
- Department of Neonatology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Atsushi Nakao
- Department of Neonatology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Shunsuke Ichi
- Department of Neurosurgery, Japanese Red Cross Medical Center, Tokyo, Japan
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Cho HC, Hwang JH. Case of Mental Retardation Associated with Aplasia Cutis Congenita and Skull Defect. NEONATAL MEDICINE 2021. [DOI: 10.5385/nm.2021.28.1.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Scotti A, Benanti E, Augelli F, Baruffaldi Preis FW. A Case of Large Aplasia Cutis Congenita with Underlying Skull Defect: Effective Surgical Treatment with Integra® Dermal Regeneration Template. Pediatr Neurosurg 2021; 56:268-273. [PMID: 33827083 DOI: 10.1159/000512022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/04/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION 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. CASE REPORT 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. DISCUSSION 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.
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Affiliation(s)
- Andrea Scotti
- Department of Plastic Surgery, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Elisa Benanti
- Department of Plastic Surgery, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Federica Augelli
- Department of Plastic Surgery, Niguarda Ca' Granda Hospital, Milan, Italy
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A practical approach to the evaluation and treatment of an infant with aplasia cutis congenita. J Perinatol 2018; 38:110-117. [PMID: 29048413 DOI: 10.1038/jp.2017.142] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 07/12/2017] [Accepted: 08/03/2017] [Indexed: 12/26/2022]
Abstract
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.
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Blionas A, Giakoumettis D, Antoniades E, Drosos E, Mitsios A, Plakas S, Sfakianos G, Themistocleous MS. Aplasia cutis congenita: Two case reports and discussion of the literature. Surg Neurol Int 2017; 8:273. [PMID: 29204308 PMCID: PMC5691551 DOI: 10.4103/sni.sni_188_17] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Accepted: 08/23/2017] [Indexed: 11/04/2022] Open
Abstract
Background: Aplasia cutis congenita (ACC) is a part of a heterogeneous group of conditions characterized by the congenital absence of epidermis, dermis, and in some cases, subcutaneous tissues or bone usually involving the scalp vertex. There is an estimated incidence of 3 in 10,000 births resulting in a total number of 500 reported cases to date. The lesions may occur on every body surface although localized scalp lesions form the most frequent pattern (70%). Complete aplasia involving bone defects occurs in approximately 20% of cases. ACC can occur as an isolated defect or can be associated with a number of other congenital anomalies such as limb anomalies or embryologic malformations. In patients with large scalp and skull defects, there is increased risk of infection and bleeding along with increased mortality and therefore prompt and effective management is advised. Case Description: We describe two cases of ACC, involving a 4 × 3 cm defect managed conservatively and a larger 10 × 5 cm defect managed surgically with the use of a temporo-occipital scalp flap. Both cases had an excellent outcome. Conclusions: Multiple treatment regimens exist for ACC, but there is no consensus on treatment strategies. Conservative treatment has been described and advocated, but many authors have emphasized the disadvantages of this treatment modality. Decision between conservative and surgical management must be individualized according to lesion size and location.
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Affiliation(s)
- Alexandros Blionas
- Department of Neurosurgery, Asklepieion Hospital of Voula, Voula, Greece
| | - Dimitrios Giakoumettis
- Department of Neurosurgery, University of Athens Medical School, "Evangelismos" General Hospital, Athens, Greece
| | - Elias Antoniades
- Department of Neurosurgery, University of Thessaloniki Medical School, "AHEPA" University Hospital, Thessaloniki, Greece
| | - Evangelos Drosos
- Department of Neurosurgery, University of Athens Medical School, "Evangelismos" General Hospital, Athens, Greece
| | - Andreas Mitsios
- Department of Neurosurgery, Children's Hospital "Agia Sofia", Athens, Greece
| | - Sotirios Plakas
- Department of Neurosurgery, Kings College Hospital NHS Foundation Trust, London, UK
| | - Georgios Sfakianos
- Department of Neurosurgery, Children's Hospital "Agia Sofia", Athens, Greece
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Clinical Application of Acellular Dermal Matrix in the Treatment of Aplasia Cutis Congenita on Scalp. J Craniofac Surg 2017; 28:e788-e789. [DOI: 10.1097/scs.0000000000004050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Conservative Treatment of Large Aplasia Cutis Congenita of the Scalp With Bone Defect With Basic Fibroblast Growth Factor Application. J Craniofac Surg 2017; 28:e154-e158. [PMID: 28045831 DOI: 10.1097/scs.0000000000003347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
The object of this report is to share our experience of conservative management of giant aplasia cutis congenita (ACC) of the scalp with the topical application of basic fibroblast growth factor (bFGF). Complete epithelialization of the 9 × 8 cm sized defect was achieved in 33 weeks. Careful conservative management could eliminate the requirement of surgery for giant ACC defects of the scalp with bone defects and should be tried if surgery is thought to be risky or has consecutive morbidity. Topical bFGF application seems to accelerate healing, also providing a better epithelium for later reconstructive treatments and its usage could be standardized in the future.
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A Novel Local Autologous Bone Graft Donor Site After Scalp Tissue Expansion in Aplasia Cutis Congenita. J Craniofac Surg 2016; 27:904-7. [PMID: 27192637 DOI: 10.1097/scs.0000000000002620] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Aplasia cutis congenita (ACC) is a rare condition often presenting as an absent area of cutaneous scalp. The calvarium and dura may also be affected. Scalp reconstruction with tissue expansion is often needed for large defects. Patients involving deficient calvarial bone present a dilemma for the reconstructive surgeon, because bone graft donor sites are limited in young children.A thick, bony rim has been noted to form around the periphery of scalp tissue expanders. The authors present a series of 3 patients with ACC for whom this bony hyperostosis was used as donor particulate bone graft at the time of scalp tissue expansion. There was 85 to 100% graft ossification on postoperative computed tomography scan. There were no bone graft-related complications.In conclusion, the hyperostotic rim that forms after scalp tissue expansion can be successfully used as particulate bone graft, decreasing the number of procedures needed for patient with ACC and obviating the need for other donor sites.
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Gencel E, Eser C, Tabakan I, Kesiktas E, Yavuz M. Outcomes of Tissue Expander Application for Scalp Reconstruction in Extensive Aplasia Cutis Congenita. Aesthetic Plast Surg 2016; 40:114-9. [PMID: 26537513 DOI: 10.1007/s00266-015-0584-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 10/21/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Aplasia cutis congenita (ACC) is a rare congenital disorder. The purpose of this study was to present outcomes of tissue expander application for scalp reconstruction in extensive ACC. PATIENT/METHODS In this retrospective study, medical records were reviewed for six patients who underwent serial tissue expander application for scalp reconstruction in ACC between 2000 and 2015. Patient average age was 14.5 (range, 4-25 years). One of the six cases had frontal bone defect, the others had bone and soft tissue defect at the vertex. In the newborn period, all patients have been managed by split-thickness skin grafts without cranioplasty procedures. After grafting and calvarial regeneration, one (or more) sessions of tissue expanders and scalp flap applications were performed for alopecia and soft tissue correction. Radiologic and clinical examination was performed for complications and outcomes. RESULTS Computerized tomography showed intact calvarium with patchy hyperostosis in all patients. The mean size of grafted areas was 69.5 cm(2) (range, 32-148.5 cm(2)). Minimal distal flap necrosis (6 × 1 cm) was observed in one patient. Serial scalp tissue expansion was performed with at least one session in a 1-year interval. One expander was extracted due to exposition and infection. No total flap losses and no calvarial defects were observed during follow-up (mean; 8.6 years). Clinical examination revealed acceptable cosmetic results in all patients. CONCLUSION We advocate late expander scalp reconstruction for management of extensive ACC cases. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Eyuphan Gencel
- Department of Plastic, Reconstructive and Aesthetic Surgery, Cukurova University Medical School, 01330, Saricam, Adana, Turkey.
| | - Cengiz Eser
- Department of Plastic, Reconstructive and Aesthetic Surgery, Cukurova University Medical School, 01330, Saricam, Adana, Turkey
| | - Ibrahim Tabakan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Cukurova University Medical School, 01330, Saricam, Adana, Turkey
| | - Erol Kesiktas
- Department of Plastic, Reconstructive and Aesthetic Surgery, Cukurova University Medical School, 01330, Saricam, Adana, Turkey
| | - Metin Yavuz
- Department of Plastic, Reconstructive and Aesthetic Surgery, Cukurova University Medical School, 01330, Saricam, Adana, Turkey
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Fatal superior sagittal sinus hemorrhage as a complication of aplasia cutis congenita: a case report and literature review. Forensic Sci Med Pathol 2015; 11:243-8. [PMID: 25614301 DOI: 10.1007/s12024-014-9645-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2014] [Indexed: 10/24/2022]
Abstract
Aplasia cutis congenita (ACC) is a rare condition that occurs in around 0.01% of births. Characterized by a localized absence of skin, it affects the midline of the scalp in over 80% of cases. We describe the case of an infant born via vaginal spontaneous delivery with ACC affecting the scalp. This extended to the subcutaneous tissue and bone leaving the dura mater exposed. The patient was managed conservatively. At 4 weeks of age, she had a fatal superior sagittal sinus hemorrhage. In a review of the literature, we found ten previous cases of hemorrhage of the superior sagittal sinus complicating an ACC. Including our case, ACC complicated by hemorrhage of the superior sagittal sinus shows a 36% mortality (4/11). An analysis of these cases suggests that this tends to occur between 1 and 3 months of age, though it may occur in younger neonates.
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Fröjd V, Maltese G, Kölby L, Tarnow P. Conservative Healing of an 11 × 9-cm Aplasia Cutis Congenita of the Scalp with Bone Defect. J Neurol Surg Rep 2014; 75:e220-3. [PMID: 25485218 PMCID: PMC4242817 DOI: 10.1055/s-0034-1387195] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 06/30/2014] [Indexed: 11/13/2022] Open
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.
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Affiliation(s)
- Victoria Fröjd
- The Craniofacial Unit, Department of Plastic and Reconstructive Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Giovanni Maltese
- The Craniofacial Unit, Department of Plastic and Reconstructive Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars Kölby
- The Craniofacial Unit, Department of Plastic and Reconstructive Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Peter Tarnow
- The Craniofacial Unit, Department of Plastic and Reconstructive Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
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Parental allografts in the management of Adams-Oliver syndrome. Childs Nerv Syst 2013; 29:1223-4. [PMID: 23740178 DOI: 10.1007/s00381-013-2174-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Accepted: 05/16/2013] [Indexed: 10/26/2022]
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Udayakumaran S, Mathew J, Panikar D. Dilemmas and challenges in the management of a neonate with Adams-Oliver syndrome with infected giant aplasia cutis lesion and exsanguination: a case-based update. Childs Nerv Syst 2013; 29:535-41. [PMID: 23274636 DOI: 10.1007/s00381-012-1999-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Accepted: 12/03/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Aplasia cutis is a rare developmental anomaly usually involving the calvarium, associated with a variable extent of defective formation of the scalp. Adams-Oliver syndrome is a condition mainly characterized by the congenital absence of skin, known as "aplasia cutis" which is usually limited to the vertex scalp and transverse limb defects. CASE REPORT A 17-day-old term female neonate was referred to us with an infected scalp lesion of the vertex. The lesion which is about 10 × 9 cm had signs of infection with necrotic eschar. We started the neonate on systemic parenteral antibiotics with local dressings. On day 3 of conservative management, the neonate had exsanguination due to bleeding from the midline with severe hemodynamic compromise requiring cardiopulmonary resuscitation. After controlling the bleeding with local tamponade and resuscitating the child, she was taken for early surgery. Debridement and bipedicled rotation flap of the scalp to cover the raw area was performed. On day 18, the flap started showing signs of necrosis. The neonate was taken up for debridement, and subsequently, maternal allograft of split-thickness skin was placed as a temporary wound cover. Meanwhile, the wound showed progressive epithelialization. At 1 year, the patient continued to have a non-healing area, which was later successfully covered with a split-thickness skin graft. We plan to revaluate the need for cranioplasty at around 3-4 years of age. DISCUSSION We discuss the dilemmas and challenges involved in the successful management of a neonate with Adams-Oliver syndrome with infected aplasia cutis and an episode of life-threatening exsanguination. CONCLUSION Aplasia cutis is a rare developmental anomaly usually involving the calvarium, associated with defective formation of the scalp to a varying extent and severity, requiring various timely strategies.
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Affiliation(s)
- Suhas Udayakumaran
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Amrita Institute of Medical Sciences and Research Centre, PO Ponekkara, Kochi 682041, India.
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Al-Hadithy N, Mennie J, Stewart K. Two different management modalities in a two sibling case report of Adams Oliver syndrome. BMJ Case Rep 2011; 2011:bcr.10.2011.4965. [PMID: 22670005 DOI: 10.1136/bcr.10.2011.4965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The authors report two-sibling case of Adams Oliver syndrome. One was managed with early surgical intervention after a period of failed conservative management and the other conservatively managed until reconstruction and surgical correction of alopecia. The goal of treatment is to achieve a complete closure of the defect without encountering any fatal complications such as haemorrhage and infection or causing any long-term neurological morbidity. Various papers have been published related to ACC, yet there is no consensus on the therapeutic approach. The management decision hinges upon balancing the risks of complications including spontaneous sagittal sinus haemorrhage and the risk of surgical intervention. Both treatment modalities proved successful in these cases.
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Affiliation(s)
- Nada Al-Hadithy
- Plastic Surgery Department, St John's Hospital, Livingston, UK.
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Affiliation(s)
- Ji Young Kim
- Department of Pediatrics, Cheil General Hospital, College of Medicine, Kwandong University, Seoul, Korea
| | - Yeon Kyung Lee
- Department of Pediatrics, Cheil General Hospital, College of Medicine, Kwandong University, Seoul, Korea
| | - Sun Young Ko
- Department of Pediatrics, Cheil General Hospital, College of Medicine, Kwandong University, Seoul, Korea
| | - Kyung A Kim
- Department of Pediatrics, Cheil General Hospital, College of Medicine, Kwandong University, Seoul, Korea
| | - Son Moon Shin
- Department of Pediatrics, Cheil General Hospital, College of Medicine, Kwandong University, Seoul, Korea
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Tröbs RB, Barenberg K, Hemminghaus M, Günther M, Neid M. Herniation of the brain after conservative treatment of a large congenital skull defect in an infant with Adams-Oliver syndrome. J Pediatr Surg 2010; 45:2064-7. [PMID: 20920732 DOI: 10.1016/j.jpedsurg.2010.06.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2009] [Revised: 05/22/2010] [Accepted: 06/13/2010] [Indexed: 10/19/2022]
Abstract
We report the case of a newborn baby with a large congenital skull defect owing to Adams-Oliver syndrome. An initial attempt at conservative treatment failed and led to disruption of the leptomeningeal membrane and prolapse of the brain. After local debridement, delayed and stepwise surgical closure was complicated by cerebrospinal fluid leakage, which required the insertion of a cerebrospinal fluid shunt. This case report highlights the potential serious risks of nonsurgical management of largely extended congenital skull defects.
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Affiliation(s)
- Ralf-Bodo Tröbs
- Department of Pediatric Surgery, Catholic Foundation Marienhospital Herne, Ruhr-University of Bochum, Widumer Str 8, D-44627 Herne, Germany.
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Abstract
Aplasia cutis congenita is a rare, sporadic congenital malformation characterized by skin defects, sometimes extending to the underlying bone. We report a case of a boy born with a large rhomboid scalp and skull defect measuring 8 × 12 cm with no other anomalies. Conservative treatment led to the complete epithelization of the skin defect with secondary closure of the cranial vault without need for surgical intervention.
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Affiliation(s)
- Mirta Starcevic
- Department of Pediatrics, Sestre Milosrdnice University Hospital Zagreb, Zagreb, Croatia.
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Yéo S, Perrot P, Bellier-Waast F, David A, Duteille F. [The Adams-Oliver syndrome. A case report]. ACTA ACUST UNITED AC 2010; 29:274-6. [PMID: 20727808 DOI: 10.1016/j.main.2010.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Revised: 03/09/2010] [Accepted: 06/29/2010] [Indexed: 11/18/2022]
Abstract
The authors report a case of Adams-Oliver syndrome in an 11 months child. This child was referred to our unit at the age of six months with right hand brachydactyly and alopecia on the vertex. We decided not to treat hand malformations, given the lack of functional impact. Alopecia of the vertex was corrected by tissue expansion of the scalp, with a satisfactory cosmetic result at five months.
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Abe M, Syuto T, Yokoyama Y, Ishikawa O. Aplasia cutis congenita after methimazole exposurein uterosuccessfully treated with basic fibroblast growth factor. Int J Dermatol 2010; 49:334-5. [DOI: 10.1111/j.1365-4632.2009.04254.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Khashab ME, Rhee ST, Pierce SD, Khashab YE, Nejat F, Fried A. Management of large scalp and skull defects in a severe case of Adams-Oliver syndrome. J Neurosurg Pediatr 2009; 4:523-7. [PMID: 19951037 DOI: 10.3171/2009.7.peds09220] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Adams-Oliver syndrome is a rare congenital disorder that includes congenital scalp and skull defects, variable degrees of terminal transverse limb anomalies, and cardiac malformations. Cutis aplasia occurring in 75% of patients is a potentially life-threatening condition. Large skin defects that cannot be closed primarily present a management dilemma, and may require skin grafting or flaps, or a combination of both operative and conservative modalities. The authors' experience in management of huge scalp and bone defects with the Integra Dermal Regeneration Template and regular dressing changes showed good scalp repair and no serious complications attributed to this approach.
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Affiliation(s)
- Mostafa El Khashab
- Department of Neurosurgery, Hackensack University Medical Center, Hackensack, NJ, USA
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Silva JCD, Almeida JPCD, Serra S, Faquini I, Quinino S, Magalhães FNDO, Azevedo-Filho H. Aplasia cutis congenita of the scalp. ARQUIVOS DE NEURO-PSIQUIATRIA 2008; 66:752-4. [PMID: 18949278 DOI: 10.1590/s0004-282x2008000500030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Joacil C da Silva
- Department of Neurosurgery, Hospital da Restauração, Recife, PE, Brazil
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Iwayama H, Hosono H, Yamamoto H, Oshiro M, Ueda N. Aplasia cutis congenita with skull defect in a monozygotic twin after exposure to methimazole in utero. ACTA ACUST UNITED AC 2007; 79:680-4. [PMID: 17803201 DOI: 10.1002/bdra.20395] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Aplasia cutis congenita (ACC) is a condition in which localized or widespread areas of skin are absent at birth. Defective lesions show complete absence of all layers of skin, occasionally extending to skull or dura. ACC is etiologically heterogeneous; many different etiologies including teratogens have been documented. CASE We describe the first reported case of a monozygotic twin with ACC after exposure to methimazole in utero. The female patient was born at 36 weeks gestation as the first child of monozygotic twins. The mother received methimazole between the 11th and 17th weeks of pregnancy because of transient hyperthyroidism. The second child did not have ACC. The patient had defects of the scalp, skull, and dura (7 x 5 cm) on the sagittal line of the parieto-occipital region. No other malformations were noted. The scalp defect has been treated daily with sterile physiological saline and petrolatum dressing in addition to intravenous antibiotics. Trafermin, a recombinant human fibroblast growth factor, was sprayed from day 6 to promote epithelialization of the scalp defect. On day 21, she had high fever due to infection of the defect lesion, which was controlled by povidone iodine dressing and intravenous antibiotics. The defect of the scalp was well healed after 6 weeks, but the skull defect remained unclosed. CONCLUSIONS We describe a rare case of a monozygotic twin with ACC and skull defect after methimazole exposure in utero. The findings of our case suggest that methimazole is a potential teratogen of ACC.
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Affiliation(s)
- Hideyuki Iwayama
- Department of Pediatrics, Ogaki Municipal Hospital, Ogaki, Gifu, Japan.
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Brecht M, Schreier S, Adam K, Vielhaber H. Isolierte ausgedehnte familiäre Aplasia cutis des Schädels. Monatsschr Kinderheilkd 2007. [DOI: 10.1007/s00112-007-1637-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gan YC, Steinbok P. Aplasia cutis congenita of the scalp: is there a better treatment strategy? Childs Nerv Syst 2006; 22:1216-7; author reply 1218-9. [PMID: 16924505 DOI: 10.1007/s00381-006-0224-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2006] [Indexed: 11/28/2022]
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