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Freedman JD, Gehring MB, O’Neill BR, French B, Khechoyan D. Repair of an Occipital Meningocele and Scalp Soft-tissue Reconstruction in a Newborn Patient. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5663. [PMID: 38463706 PMCID: PMC10923347 DOI: 10.1097/gox.0000000000005663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/19/2024] [Indexed: 03/12/2024]
Abstract
The differential diagnosis of large congenital scalp defects includes aplasia cutis and encephalocele, among others. Treatment includes conservative management with dressings or operative management with dermal substitutes, skin grafting, local flaps, and free flaps. This case report discusses the technical considerations and reconstructive strategies for repair of a meningocele in a newborn with a large 5.5-cm scalp defect. The key strategies include preemptive cerebrospinal fluid (CSF) diversion with external ventricular drain to reduce the risk of CSF leak and mitigate wound-healing complications; careful identification and avoidance of key anatomic structures, such as the superior sagittal sinus, as anatomy may be significantly distorted due to the presence of a meningocele and after CSF diversion; and careful, thoughtful design of the local scalp flaps to maximize blood supply and to avoid tension on the final reconstruction.
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Affiliation(s)
- Jonathan D. Freedman
- From the Division of Plastic Surgery, Department of Surgery, University of Colorado, Aurora, Colo
| | - Michael B. Gehring
- From the Division of Plastic Surgery, Department of Surgery, University of Colorado, Aurora, Colo
| | | | - Brooke French
- From the Division of Plastic Surgery, Department of Surgery, University of Colorado, Aurora, Colo
| | - David Khechoyan
- From the Division of Plastic Surgery, Department of Surgery, University of Colorado, Aurora, Colo
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Ren F, Bressler L, Pruitt L, Wang H, Liu L, Elston DM. Midline cutaneous anomalies of the craniospinal axis. J Am Acad Dermatol 2023; 89:1238-1244. [PMID: 37598328 DOI: 10.1016/j.jaad.2023.06.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/28/2023] [Accepted: 06/26/2023] [Indexed: 08/21/2023]
Abstract
Patients with midline cutaneous anomalies of the craniospinal axis can be indicative of underlying embryonic defects, such as neural tube defects. Lack of familiarity with these midline aberrant skin findings may lead to misdiagnosis and delayed treatment. In this review, midline cutaneous anomalies of the craniospinal axis including aplasia cutis congenita, cranial and spinal dysraphism, and other developmental anomalies are explored in detail with emphasis on cutaneous clues to the diagnosis and appropriate workup.
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Affiliation(s)
- Faliang Ren
- Department of Dermatology, Children's Hospital of Chongqing Medical University, Chongqing, China; Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Lindsey Bressler
- Department of Dermatology & Dermatological Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Laura Pruitt
- Department of Dermatology & Dermatological Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Hua Wang
- Department of Dermatology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Li Liu
- Department of Dermatology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Dirk M Elston
- Department of Dermatology & Dermatological Surgery, Medical University of South Carolina, Charleston, South Carolina
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Muacevic A, Adler JR, Alallah B, Alallah J. Aplasia Cutis Congenita of the Lower Limb: A Case Report. Cureus 2023; 15:e33376. [PMID: 36751246 PMCID: PMC9898798 DOI: 10.7759/cureus.33376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2023] [Indexed: 01/06/2023] Open
Abstract
Aplasia cutis congenita type VI is a genetic disorder that presents with congenital skin absence, blistering, and nail abnormalities. We present the case of a male newborn who presented with an absence of skin in the entire left leg and the lower part of the left thigh. On the second day of life, he had new skin lesions that started to appear over the fingernail beds, nasal bridge, thighs, and buttocks. There were no other associated anomalies such as pyloric atresia, renal abnormalities, or ureteral stenosis. A diagnosis of Bart's syndrome was made based on clinical diagnosis and previous presentation in the family. The patient developed sepsis and osteomyelitis of the lower limb and eventually died.
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Amaaoune F, Chakiri R. Congenital cutaneous aplasia of the limbs: A case report. Ann Med Surg (Lond) 2022; 76:103496. [PMID: 35495396 PMCID: PMC9052171 DOI: 10.1016/j.amsu.2022.103496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/01/2022] [Accepted: 03/06/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Congenital skin aplasia, or aplasia cutis congenita (ACC), is a rare congenital anomaly. The incidence is estimated to be between 0.5 and 1 in 10,000 births. We report an observation of ACC of the limbs in a female newborn at D3 of life. Case report Female newborn at D3 of life, born at term by vaginal delivery with a birth weight of 2, 900kg. The general examination revealed a hemodynamically and respiratorily stable and apyretic newborn. The dermatological examination noted the presence of translucent exulcerations on both wrists, the inner side of the left knee, and the distal end of the left leg. In view of this clinical aspect, the diagnosis of ACC was evoked. The management was to hospitalize the newborn in a neonatology unit, do a biological check-up with a trans-fontanelle ultrasound, echocardiography, and abdominal ultrasound, associated with daily care. Discussion Many hypotheses have been put forward to explain the pathophysiological mechanism of CCA, whether isolated or associated with other anomalies. However, at present, the origin of this malformation remains unknown. There is no unambiguous management in the initial phase, as it depends on the type of CCA. Conclusion Because of the different possible clinical presentations and existing syndromic associations, it can be thought that it corresponds to a phenotypic expression of various origins, which may be interrelated. Congenital skin aplasia, or aplasia cutis congenita (ACC), is a rare congenital abnormality. The malformation is characterized by a localized absence of the various components of the skin. It can affect the entire skin surface. Management of Congenital skin aplasia is controversial, but most cases heal spontaneously within a few weeks with a conservative approach.
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Wu Y, Liu J, Luo Q. Isolated aplasia cutis congenita: A report of two cases. Clin Case Rep 2021; 9:e04671. [PMID: 34430025 PMCID: PMC8365854 DOI: 10.1002/ccr3.4671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/03/2021] [Accepted: 07/12/2021] [Indexed: 11/09/2022] Open
Abstract
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.
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Affiliation(s)
- Yan Wu
- Department of Obstetrics and GynecologyZhejiang University School of Medicine Women's HospitalHangzhou CityChina
- Department of Obstetrics and GynecologyWomen and Children's Hospital of Jiaxing UniversityJiaxingChina
| | - Jun Liu
- Pediatric Surgery DepartmentWomen and Children's Hospital of Jiaxing UniversityJiaxingChina
| | - Qiong Luo
- Department of Obstetrics and GynecologyZhejiang University School of Medicine Women's HospitalHangzhou CityChina
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Yang MY, Ha DL, Kim HS, Ko HC, Kim BS, Kim MB. Aplasia cutis congenita in Korea: Single center experience and literature review. Pediatr Int 2020; 62:804-809. [PMID: 32037608 DOI: 10.1111/ped.14192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 01/31/2020] [Accepted: 02/04/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Aplasia cutis congenita (ACC) is a rare congenital malformation characterized by a localized absence of skin. which most commonly affects the scalp. We performed the present study to elucidate the basic clinical data regarding ACC in Korea, including demographics, clinical features, radiological and therapeutic results. METHODS Fifty-nine patients (70 lesions) with ACC (35 from our department and 24 from a Koreamed database search) were enrolled. We assessed demographics, family and obstetrical histories, clinical features (multiplicity, subtype, size, shape, hair collar sign, location, and Frieden's classification), and radiologic and therapeutic results. RESULTS The mean age of patients was 2.62 years, with a male-to-female ratio of 1.03. A minority of patients had a family history (three patients), birth trauma (one patient), maternal drug use (two patients), or human immunodeficiency virus infection (one patient) during pregnancy, and fetus papyraceus of placental infarcts (two patients). Six patients (6/59, 10.17%) had multiple lesions. Scarring was the most common manifestation (39/70, 55.71%). The scalp was the most commonly affected site (50 cases, 71.43%). Thirty-nine patients (66.10%) met Frieden's type I classification (scalp ACC without multiple anomalies). Radiological investigations were performed in 30 patients (30/59, 50.85%) with abnormal findings in eight patients. Twenty-five patients (42.37%) were managed conservatively, and 17 patients (28.81%) were treated with local wound care. CONCLUSIONS This is the first and largest study assessing the basic clinical data of ACC in Korea. The results of the present study could be useful for pediatricians and dermatologists who routinely manage ACC.
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Affiliation(s)
- Min-Young Yang
- Department of Dermatology, Pusan National University Hospital, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Dae-Lyong Ha
- Department of Dermatology, Pusan National University Hospital, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hoon-Soo Kim
- Department of Dermatology, Pusan National University Hospital, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hyun-Chang Ko
- Department of Dermatology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Byung-Soo Kim
- Department of Dermatology, Pusan National University Hospital, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Moon-Bum Kim
- Department of Dermatology, Pusan National University Hospital, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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Charvillat O, Plancq MC, Haraux E, Tourneux P, Gouron R, Klein C. Aplasia cutis congenita of both knees: A new therapeutic strategy. Arch Pediatr 2020; 27:277-280. [PMID: 32417075 DOI: 10.1016/j.arcped.2020.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 05/02/2020] [Indexed: 10/24/2022]
Abstract
Aplasia cutis congenita is defined as the absence of all layers of the skin. The condition involves mainly the scalp but it can affect any area of skin on the body. A clear therapeutic strategy is not available. Here, we describe the 6-year clinical outcome of a patient with aplasia cutis congenita of both knees following treatment with an artificial dermis and a thin skin graft.
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Affiliation(s)
- O Charvillat
- Department of Pediatric Orthopedic Surgery, Amiens University Medical Center and Jules Verne University of Picardie, 80054 Amiens cedex 1, France
| | - M-C Plancq
- Department of Pediatric Orthopedic Surgery, Amiens University Medical Center and Jules Verne University of Picardie, 80054 Amiens cedex 1, France
| | - E Haraux
- Department of Pediatric Orthopedic Surgery, Amiens University Medical Center and Jules Verne University of Picardie, 80054 Amiens cedex 1, France
| | - P Tourneux
- Médecine néonatale et réanimation pédiatrique, pôle femme-couple-enfant, groupe hospitalier Sud, 80054 Amiens cedex 1, France
| | - R Gouron
- Department of Pediatric Orthopedic Surgery, Amiens University Medical Center and Jules Verne University of Picardie, 80054 Amiens cedex 1, France
| | - C Klein
- Department of Pediatric Orthopedic Surgery, Amiens University Medical Center and Jules Verne University of Picardie, 80054 Amiens cedex 1, France.
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Kojmane W, Hmami F, Atmani S. [Adams-Oliver syndrome and cutis marmorata telangiectatica congenita]. Ann Dermatol Venereol 2019; 146:223-225. [PMID: 30638685 DOI: 10.1016/j.annder.2018.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/24/2018] [Accepted: 11/21/2018] [Indexed: 12/01/2022]
Abstract
Adams-Oliver syndrome (AOS) is a congenital condition characterized by congenital aplasia cutis and transverse limb defects. Herein we report a case of an infant with severe intra-uterine growth restriction presenting AOS associated with cutis marmorata telangiectatica but with no other organ complications. The outcome was complicated by hemorrhagic and septic shock, which resulted in the death of the infant in a setting of multiorgan failure.
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Affiliation(s)
- W Kojmane
- Service de néonatologie et réanimation néonatale, CHU Hassan II, Fès, Maroc.
| | - F Hmami
- Service de néonatologie et réanimation néonatale, CHU Hassan II, Fès, Maroc
| | - S Atmani
- Service de néonatologie et réanimation néonatale, CHU Hassan II, Fès, Maroc
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