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Zhou F, Wang S, Qin H, Zeng H, Ye J, Yang J, Cai G, Wu Z, Zhang Z. Genome-wide association analysis unveils candidate genes and loci associated with aplasia cutis congenita in pigs. BMC Genomics 2023; 24:701. [PMID: 37990155 PMCID: PMC10664689 DOI: 10.1186/s12864-023-09803-6] [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: 08/06/2023] [Accepted: 11/11/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Aplasia cutis congenita (ACC) is a rare genetic disorder characterized by the localized or widespread absence of skin in humans and animals. Individuals with ACC may experience developmental abnormalities in the skeletal and muscular systems, as well as potential complications. Localized and isolated cases of ACC can be treated through surgical and medical interventions, while extensive cases of ACC may result in neonatal mortality. The presence of ACC in pigs has implications for animal welfare. It contributes to an elevated mortality rate among piglets at birth, leading to substantial economic losses in the pig farming industry. In order to elucidate candidate genetic loci associated with ACC, we performed a Genome-Wide Association Study analysis on 216 Duroc pigs. The primary goal of this study was to identify candidate genes that associated with ACC. RESULTS This study identified nine significant SNPs associated with ACC. Further analysis revealed the presence of two quantitative trait loci, 483 kb (5:18,196,971-18,680,098) on SSC 5 and 159 kb (13:20,713,440-207294431 bp) on SSC13. By annotating candidate genes within a 1 Mb region surrounding the significant SNPs, a total of 11 candidate genes were identified on SSC5 and SSC13, including KRT71, KRT1, KRT4, ITGB7, CSAD, RARG, SP7, PFKL, TRPM2, SUMO3, and TSPEAR. CONCLUSIONS The results of this study further elucidate the potential mechanisms underlying and genetic architecture of ACC and identify reliable candidate genes. These results lay the foundation for treating and understanding ACC in humans.
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Affiliation(s)
- Fuchen Zhou
- College of Animal Science and National Engineering Research Center for Breeding Swine Industry, South China Agricultural University, Guangdong, 510642, P.R. China
| | - Shenghui Wang
- Guangdong Wens Breeding Swine Technology Co., Ltd, Guangdong, 527400, P.R. China
| | - Haojun Qin
- College of Animal Science and National Engineering Research Center for Breeding Swine Industry, South China Agricultural University, Guangdong, 510642, P.R. China
| | - Haiyu Zeng
- Guangdong Wens Breeding Swine Technology Co., Ltd, Guangdong, 527400, P.R. China
| | - Jian Ye
- Guangdong Wens Breeding Swine Technology Co., Ltd, Guangdong, 527400, P.R. China
| | - Jie Yang
- College of Animal Science and National Engineering Research Center for Breeding Swine Industry, South China Agricultural University, Guangdong, 510642, P.R. China
| | - Gengyuan Cai
- College of Animal Science and National Engineering Research Center for Breeding Swine Industry, South China Agricultural University, Guangdong, 510642, P.R. China
- Guangdong Wens Breeding Swine Technology Co., Ltd, Guangdong, 527400, P.R. China
| | - Zhenfang Wu
- College of Animal Science and National Engineering Research Center for Breeding Swine Industry, South China Agricultural University, Guangdong, 510642, P.R. China.
- Guangdong Wens Breeding Swine Technology Co., Ltd, Guangdong, 527400, P.R. China.
| | - Zebin Zhang
- College of Animal Science and National Engineering Research Center for Breeding Swine Industry, South China Agricultural University, Guangdong, 510642, P.R. China.
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Lucena MH, Zauk A. Large Skin Lesion and Bilious Emesis in a Premature Newborn. Neoreviews 2022; 23:782-787. [PMID: 36316258 DOI: 10.1542/neo.23-10-e782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Michelle H Lucena
- Division of Neonatology, Albert Einstein School of Medicine, Children's Hospital at Montefiore, Bronx, NY
| | - Adel Zauk
- Division of Neonatology, St Joseph's University Medical Center, Paterson, NJ
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Ngeow A, Hui C, Chua AWC, Koh M, Ong YS, Poon WB. Challenges in the management of extensive aplasia cutis congenita. BMJ Case Rep 2022; 15:e246627. [PMID: 35165127 PMCID: PMC8845208 DOI: 10.1136/bcr-2021-246627] [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] [Accepted: 01/20/2022] [Indexed: 11/04/2022] Open
Abstract
Aplasia cutis congenita (ACC) is a rare group of congenital disorders characterised by focal or widespread absence of skin, predominantly affecting the scalp. A Malay female infant was born at 37 weeks with extensive ACC, affecting 37% of total body surface area, including her scalp and trunk. There is no consensus on the management of ACC given the rarity and variable presentation. A multi-disciplinary team comprising neonatologists, paediatric dermatologists, plastic surgeons and medical laboratory scientists at the skin bank, employed a more aggressive surgical approach with the aim of avoiding potentially catastrophic morbidity, including sagittal sinus haemorrhage and brain herniation. Out of several surgical options, the team used a staged artificial dermal matrix (Integra) and cultured epithelial autograft application, followed by regular wound dressing, and eventually allowed the child to achieve complete epithelialisation of her trunk, and most of scalp before she was discharged from hospital.
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Affiliation(s)
- Alvin Ngeow
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore
| | - Cheryl Hui
- Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
| | | | - Mark Koh
- Department of Dermatology, KK Women's and Children's Hospital, Singapore
| | - Yee Siang Ong
- Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
| | - Woei Bing Poon
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore
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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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Thadchanamoorthy V, Dayasiri K, Thirukumar M, Thamilvannan N, Chandraratne SH. Multiple aplasia cutis congenita type V and fetus papyraceous: a case report and review of the literature. J Med Case Rep 2021; 15:110. [PMID: 33658072 PMCID: PMC7931332 DOI: 10.1186/s13256-021-02662-3] [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: 09/13/2020] [Accepted: 01/04/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Aplasia cutis congenita is regarded as congenital focal absence of skin in the newborn, and occurrence of more than three similar skin defects is rare. The etiology is thought to be multifactorial, and precise etiopathogenesis is unknown. CASE PRESENTATION A 13-day-old newborn Sri Lankan Tamil girl was referred to the dermatologic clinic with multiple skin defects at birth. There were six lesions on the body, and two of them had healed during intrauterine period, leaving scars. This was a second twin of her pregnancy. Her first twin fetus had demised before 19 weeks of pregnancy and was confirmed to be fetus papyraceous based on ultrasound-guided fetal assessment. The said child was thoroughly investigated and found to have no other congenital abnormalities. Chromosomal studies yielded normal findings. She was treated with tropical antibacterial ointment, and all lesions resolved spontaneously within 4 weeks, leaving scars. Physiotherapy was commenced to prevent contracture formation, and follow-up was arranged in collaboration with the plastic surgical team. CONCLUSIONS Aplasia cutis congenita is a rare condition of uncertain etiology, but consanguinity may play a role. This report described a newborn with type V cutis aplasia congenita in whom the diagnosis was confirmed based on clinical features and revision of antenatal history. The management depends on the pattern, extent, location, severity, underlying causes, and associated anomalies.
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Affiliation(s)
- V Thadchanamoorthy
- Faculty of Health Care Sciences, Eastern University, Chenkalady, Sri Lanka
| | | | - M Thirukumar
- Faculty of Health Care Sciences, Eastern University, Chenkalady, Sri Lanka
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Topical Leptospermum Honey in the Management of Aplasia Cutis Congenita in Neonates. J Wound Ostomy Continence Nurs 2019; 46:343-345. [DOI: 10.1097/won.0000000000000541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Arslanca SB, Arslanca T, Koç A. Aplasia cutis congenita: a case report. J OBSTET GYNAECOL 2019; 39:860-861. [PMID: 31023179 DOI: 10.1080/01443615.2019.1581753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Seyma Banu Arslanca
- a Department of Obstetrics and Gynecology , Ankara University Faculty of Medicine , Ankara , Turkey
| | - Tufan Arslanca
- b Department of Obstetrics and Gynecology, Yenimahalle Education and Research Hospital , Yıldırım Beyazıt University , Ankara , Turkey
| | - Acar Koç
- a Department of Obstetrics and Gynecology , Ankara University Faculty of Medicine , Ankara , Turkey
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Magliah T, Alghamdi F. Aplasia Cutis Congenita: A Case Report. Case Rep Dermatol 2018; 10:182-186. [PMID: 30057534 PMCID: PMC6062690 DOI: 10.1159/000490786] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 06/09/2018] [Indexed: 11/19/2022] Open
Abstract
Background Aplasia cutis congenita is characterized by congenital focal absence of skin in a newborn. Case Report A 45-day-old boy presented to the outpatient clinic of dermatology at King Abdul Aziz Medical City, Jeddah, Saudi Arabia, with a flat scalp lesion on the space of the anterior fontanel. There was a positive family history of such condition in his older brother's scalp, which resolved spontaneously within 3 weeks after labor, without any medical intervention. There were no associated hemangiomata or other congenital defects in his body. The case was admitted to the hospital. Ultrasound of the head showed bullae over the anterior fontanel, well-defined complex cyst, and an isolated subcutaneous lesion, with no evidence of intracranial extension. The baby was started on intravenous infusion of vancomycin (67 mg in dextrose 5% in water) for 3 days, but no improvement occurred to the scalp cyst. The baby started to receive 15 g of 2% mupirocin ointment, topically three times daily. After 2 days, the scalp cyst gradually decreased in size and became dry within 1 week. Follow-up after 3 months showed that the scalp lesion completely healed, leaving a very small atrophic scar and no further management of the lesion was needed. Conclusions Aplasia cutis congenita is a rare condition of uncertain etiology, but consanguinity may play a role. Its management depends on its pattern, location, underlying causes, and associated anomalies.
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Affiliation(s)
- Tahani Magliah
- Resident of Dermatology, National Guard Hospital, King Abdul Aziz Medical City, Jeddah, Saudi Arabia
| | - Faiza Alghamdi
- Consultant Dermatologist, National Guard Hospital, King Abdul Aziz Medical City, Jeddah, Saudi Arabia
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LDT classification and therapeutic strategy of congenital body wall defects. J Plast Reconstr Aesthet Surg 2017; 71:384-393. [PMID: 29029959 DOI: 10.1016/j.bjps.2017.09.002] [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: 11/21/2016] [Revised: 07/09/2017] [Accepted: 09/04/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Repairing body wall defects is a critical step in the treatment of some congenital deformities, and this procedure may need the help from plastic surgeons. Although there are many articles about congenital deformities, body wall defects of these malformations are rarely studied as independent targets. METHODS In this article, the authors present an LDT classification for congenital body wall defects according to the position of the defects, the tissue layers involved, and the surgical urgency, each of which is represented by letters L, D, and T, respectively. That is, the defects in different areas (L), full-thickness (D1), or partial (D0A, D0B) defects, defects needing instant repair (T2), semi-elective repair (T1), or elective repair (T0). Based on this classification system, the authors have performed body wall reconstruction on two pairs of thoraco-omphalopagus twins, one pair of ischiopagus tetrapus twins, and an infant and an adult, both of whom were diagnosed with pentalogy of Cantrell associated with ectopia cordis. RESULTS Except for one pair of thoraco-omphalopagus twins who died after emergency separation, all the other patients survived. Another pair of thoraco-omphalopagus twins suffered from wound dehiscence and partial flap necrosis, respectively, after surgery. An expanded polytetrafluoroethylene mesh in one sister of the ischiopagus twins was removed because of infection. CONCLUSIONS LDT classification not only can help doctors categorise different congenital body wall defects rapidly and easily, but can also guide the reconstruction of these defects. It may have clinical value to plastic surgeons to some extent.
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Cherubino M, Maggiulli F, Dibartolo R, Valdatta L. Treatment of multiple wounds of aplasia cutis congenita on the lower limb: a case report. J Wound Care 2017; 25:760-762. [PMID: 27974014 DOI: 10.12968/jowc.2016.25.12.760] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Aplasia cutis congenita (ACC) is a rare congenital disease, characterised by absence of skin, that can affect different parts of the body. ACC is more frequent on the scalp, but can involve limbs, with partial-or total-thickness loss of skin, with a functional impairment of the joint affected. There is no clear indication for surgical or conservative treatment, therefore, it would be helpful to find scientific support for the optimal treatment strategies. CLINICAL PRESENTATION We present a case of a newborn female, with six wounds on the inferior limbs, treated with conservative therapy. To prevent infection and promote healing, the defects were kept moist and covered with non-adherent/antimicrobical dressings. Complete wound healing occurred in eight weeks. The duration of follow-up was three years. RESULTS In this kind of ACC with superficial partial-thickness wounds of the lower limbs, conservative treatment was successful. The same conservative treatment can be proposed for larger or deeper wounds of lower limbs with no involvement of underlying structures, with delayed scar excision after the complete growth of the patient. ACC scar excision could require complex tissue rearrangement, tissue expansion, or skin grafting. CONCLUSION In the evaluation for treatment of ACC of inferior limbs, even in cases of total-thickness skin loss, even on joints, the conservative approach could be considered as the first choice. DECLARATION OF INTEREST None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript.
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Affiliation(s)
- M Cherubino
- Plastic and Reconstructive Unit, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.,University of Insubria, Varese Italy
| | - F Maggiulli
- Plastic and Reconstructive Unit, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - R Dibartolo
- Plastic and Reconstructive Unit, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - L Valdatta
- Plastic and Reconstructive Unit, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.,University of Insubria, Varese Italy
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Muñoz-Guerrero F, Muñoz-Solís AA, Ornelas-Aguirre JM. [Aplasia cutis congenita associated with epidermolysis bullosa]. CIR CIR 2016; 85 Suppl 1:76-79. [PMID: 27979363 DOI: 10.1016/j.circir.2016.10.017] [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: 02/17/2016] [Revised: 09/10/2016] [Accepted: 10/17/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Aplasia cutis congenita (ACC) is a skin condition of rare presentation, this disease is characterized by absence of skin at birth and associated with facial, skin and bone skull deformities. The diagnosis is mainly clinical. CASE REPORT Male 5 days after birth, unique product of primigravida mother and no family history of relevance. Physical examination revealed bilateral and symmetrical skin defects of both lower extremities, the disease is characterized by skin fragility, scabs, and coated pseudomembrane ulcers, decreased interdigital space between toes of the left foot, retraction of the foot and genu varum. It was handled with allograft of epidermis cultured in vitro, general wound care and clinical follow-up. DISCUSSION ACC associated with epidermolysis bullosa is one of the rarer forms of presentation. It is necessary to rule out other skin diseases. Clinical management is recommended with biological or synthetic skin cover, infection prevention, early treatment of complications and clinical follow.
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Affiliation(s)
- Félix Muñoz-Guerrero
- Unidad Médica de Alta Especialidad, Unidad de Quemados, Hospital de Especialidades No. 2, Instituto Mexicano del Seguro Social, Ciudad Obregón, Sonora, México.
| | - Adrián Antonio Muñoz-Solís
- Servicio de Urgencias Médicas, Hospital General de Zona No. 30, Instituto Mexicano del Seguro Social, Mexicali, Baja California, México
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Brzezinski P, Pinteala T, Chiriac AE, Foia L, Chiriac A. Aplasia cutis congenita of the scalp--what are the steps to be followed? Case report and review of the literature. An Bras Dermatol 2015; 90:100-3. [PMID: 25672305 PMCID: PMC4323704 DOI: 10.1590/abd1806-4841.20153078] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 10/21/2013] [Indexed: 01/14/2023] Open
Abstract
Aplasia cutis congenita is a rare malformation characterized by localized congenital
absence of the skin. It rarely occurs on the trunk and limbs, and can occur in
isolation or as part of a heterogeneous group of syndromes. We report a case of a
4-day-old boy with a 5.6-cm- diameter tumor, with a central crust, non-indurate and
no inflammatory rim; localized on the scalp and a small, atrophic hairless scar
appeared 6 months later (approximately 5cm in length) at the site of the previous
tumor.
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Affiliation(s)
| | - Tudor Pinteala
- Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Anca E Chiriac
- Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Liliana Foia
- Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
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Affiliation(s)
- Piyush Kumar
- Department of Dermatology, Katihar Medical College, Katihar, Bihar, India
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Morrow D, Schelonka R, Krol A, Davies M, Kuang A. Type V aplasia cutis congenita: case report, review of the literature, and proposed treatment algorithm. Pediatr Dermatol 2013; 30:e208-13. [PMID: 22472005 DOI: 10.1111/j.1525-1470.2012.01742.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Aplasia cutis congenita (ACC) is the congenital absence of skin. There are a number of different classifications based on distribution and associated findings. Type V ACC is unique in that the lesions are typically symmetric and found primarily on the trunk but can also include the upper and lower extremities. Type V is associated with the loss of a monozygotic co-twin during the late first or early second trimester. Here we present an extensive case of type V ACC and a review of the literature, including a summary of treatment and outcomes. From the available literature, it appears that there is no benefit from early surgical intervention, and therefore we propose a treatment algorithm that starts with conservative management.
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Affiliation(s)
- Daniel Morrow
- Division of NeonatologyDepartment of PediatricsDepartment of Pediatric Dermatology, Doernbecher Neonatal Care Center, Oregon Health and Science University, Portland, OregonCasey Eye Institute, Oregon Health and Science University, Portland, OregonDepartment of Pediatric Plastic and Reconstructive Surgery, Oregon Health and Science University, Portland, Oregon
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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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Affiliation(s)
- Fang Liu
- Department of Ultrasound; Qilu Hospital; Shandong University; Jinan Shandong Province China
- Department of ultrasound; Shandong Provincial Hospital; Shandong University; Jinan Shandong Province China
| | - Xiaoying Chen
- Department of Special Inspection; Maternal and Child Health Hospital of Decheng District; Dezhou Shandong Province China
| | - Rongzhi Tu
- Department of Special Inspection; Maternal and Child Health Hospital of Decheng District; Dezhou Shandong Province China
| | - Shaoping Liu
- Department of Ultrasound; Qilu Hospital; Shandong University; Jinan Shandong Province China
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