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Su J, Ye D, Yang L. Cryopreserved amniotic membrane in the treatment of limb skin defects of aplasia cutis congenita: a case study. J Wound Care 2023; 32:S17-S21. [PMID: 36930279 DOI: 10.12968/jowc.2023.32.sup3.s17] [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] [Indexed: 03/18/2023]
Abstract
OBJECTIVE To report the efficacy and long-term outcomes of treating the skin defects of aplasia cutis congenita (ACC) with cryopreserved amniotic membrane (AM). METHOD Human amnion was obtained from the caesarean delivery of a full-term healthy pregnancy and processed in a sterile laminar flow hood, and cryopreserved in liquid nitrogen. The structure of the AM was investigated histologically and the viability of the epithelial cells was assessed after cryopreservation and compared with fresh AM and with AM preserved in phosphate-buffered saline (PBS) at 4°C. The cryopreserved AM was applied onto the lower limb skin defects of a one-month old baby with ACC. Timely AM changes were performed as necessary until the wounds healed. RESULTS The structure of the cryopreserved AM was intact, with little visible difference compared with fresh AM. The viability of the epithelial cells was partially lost but still much better retained than in those preserved in PBS at 4°C. The limb skin defects were gradually re-epithelialised upon application of the AM and were completely healed after one month. The 4-month and 2-year follow-ups presented good skin texture and colour, without hypertrophic scar formation. CONCLUSION In this case study, cryopreservation of AM presented a well preserved stromal compartment and viable epithelial layer. It also offered features such as pain relief, good attachment and adhesiveness, improved wound healing and suppressed scar formation in the treatment of ACC skin defects.
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Affiliation(s)
- Jing Su
- Nursing Faculty, Shantou University Medical College, Shantou, China
| | - Danyan Ye
- Research Center for Translational Medicine, Shantou University Medical College, Shantou, China
| | - Lujun Yang
- Research Center for Translational Medicine, Shantou University Medical College, Shantou, China
- Department of Plastic Surgery and Burn Center, 2nd Affiliated Hospital of Shantou University Medical College, Shantou, China
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Yang XF, Shi SW, Ye Y, Chen K. A successful case of preimplantation genetic testing for monogenic disorder for aplasia cutis congenita. Front Pediatr 2022; 10:1005272. [PMID: 36458141 PMCID: PMC9705585 DOI: 10.3389/fped.2022.1005272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/18/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Aplasia cutis congenita (ACC), also called congenital cutaneous hypoplasia, is a serious disease in newborns. Children with ACC often die due to wound infections and bleeding. How the incidence of ACC can be reduced is a question that needs to be solved urgently. CASE REPORT We reported a mother who had delivered two children with ACC, both of whom were diagnosed with ACC type VI, skin defects, limb deformities, and congenital heart malformations. One infant died a few days after birth, and another died in utero in the second trimester. Genetic testing in both children showed a heterozygous mutation in the ITGB4 gene [17q25 exon 8, c. 794 dupC, (p. Ala266fs) and exon 15, c. 1860G > A]. The mother later successfully gave birth to a healthy baby using Preimplantation Genetic Testing for Monogenic disorders(PGD-M). CONCLUSION The PGD-M technique is highly valuable in reducing the incidence of ACC and improving the prognoses of newborns.
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Affiliation(s)
- Xiu-Fang Yang
- Department of Neonatology, Zhongshan Hospital Affiliated to Sun Yat-Sen University, Zhongshan, China
| | - Shang-Wen Shi
- Department of Neonatology, Zhongshan Hospital Affiliated to Sun Yat-Sen University, Zhongshan, China
| | - Yun Ye
- Reproductive Medicine Center, Zhongshan Hospital Affiliated to Sun Yat-Sen University, Zhongshan, China
| | - Kang Chen
- Molecular Inspection Center, Zhongshan Hospital Affiliated to Sun Yat-Sen University, Zhongshan, China
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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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Lei GF, Zhang JP, Wang XB, You XL, Gao JY, Li XM, Chen ML, Ning XQ, Sun JL. Treating aplasia cutis congenita in a newborn with the combination of ionic silver dressing and moist exposed burn ointment: A case report. World J Clin Cases 2019; 7:2611-2616. [PMID: 31559300 PMCID: PMC6745313 DOI: 10.12998/wjcc.v7.i17.2611] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 08/09/2019] [Accepted: 08/20/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Aplasia cutis congenita (ACC) in newborns is a condition in which congenital defects or hypoplasia is present in part of the epidermis, dermis and even subcutaneous tissue (including muscle and bones). First reported by Cordon in 1767, ACC is a rare disease with a low incidence of 1/100000 to 3/10000. Currently, there are 500 cases reported worldwide. ACC can be accompanied by other malformations. The onset mechanism of the disease remains unknown but is thought to be correlated to factors such as genetics, narrow uterus, foetal skin and amniotic membrane adhesion, use of teratogenic drugs in early pregnancy and viral infection.
CASE SUMMARY In August 2018, we treated a newborn with ACC on the left lower limbs using a combination of ionic silver dressing and moist exposed burn ointment (MEBO) and achieved a satisfactory treatment outcome. The skin defects were observed on the external genitals and on areas from the left foot to 3/4 of the upper left side. Subcutaneous tissue and blood vessels were observed in the regions with skin defects. The following treatments were provided. First, the wound was rinsed with 0.9% sodium chloride solution followed by disinfection with povidone-iodine twice. And then MEBO was applied to the wound at a thickness of approximately 1 mm. After applying ionic silver dressing, the wound was covered with sterile gauze. The wound dressing was replaced every 2-3 d. At the 4-mo follow-up, the treatment outcome was satisfactory. There was minimal scar tissue formation, and limb function was not impaired.
CONCLUSION The combination of ionic silver dressing and MEBO to ACC is helpful.
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Affiliation(s)
- Guo-Feng Lei
- Department of Neonatal Intensive Care Unit, Sanmenxia Central Hospital, Sanmenxia 472000, Henan Province, China
| | - Jun-Ping Zhang
- Department of Neonatal Intensive Care Unit, Sanmenxia Central Hospital, Sanmenxia 472000, Henan Province, China
| | - Xiao-Bing Wang
- Department of Neonatal Intensive Care Unit, Sanmenxia Central Hospital, Sanmenxia 472000, Henan Province, China
| | - Xiao-Li You
- Department of Neonatal Intensive Care Unit, Sanmenxia Central Hospital, Sanmenxia 472000, Henan Province, China
| | - Jin-Ya Gao
- Department of Intensive Care Unit, Sanmenxia Central Hospital, Sanmenxia 472000, Henan Province, China
| | - Xiao-Mei Li
- Department of Neonatal Intensive Care Unit, Sanmenxia Central Hospital, Sanmenxia 472000, Henan Province, China
| | - Mei-Ling Chen
- Reproductive endocrine center, Sanmenxia Central Hospital, Sanmenxia 472000, Henan Province, China
| | - Xiu-Qin Ning
- Department of Neonatal Intensive Care Unit, Sanmenxia Central Hospital, Sanmenxia 472000, Henan Province, China
| | - Jiang-Li Sun
- Department of Intensive Care Unit, Sanmenxia Central Hospital, Sanmenxia 472000, Henan Province, China
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Trah J, Has C, Hausser I, Kutzner H, Reinshagen K, Königs I. Integra ®-Dermal Regeneration Template and Split-Thickness Skin Grafting: A Therapy Approach to Correct Aplasia Cutis Congenita and Epidermolysis Bullosa in Carmi Syndrome. Dermatol Ther (Heidelb) 2018; 8:313-321. [PMID: 29777447 PMCID: PMC6002319 DOI: 10.1007/s13555-018-0237-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Indexed: 10/25/2022] Open
Abstract
The association of junctional epidermolysis bullosa with pyloric atresia (JEB-PA) and aplasia cutis congenita (ACC) was described by El Shafie et al. (J Pediatr Surg 14(4):446-449, 1979) and Carmi et al. (Am J Med Genet 11:319-328, 1982). Most patients die in the first weeks of life, and no curative treatment options are available so far. We describe a patient with JEB-PA and ACC (OMIM # 226730) who was treated for extensive areas of ACC by Integra®-Dermal Regeneration Template and split-thickness skin grafting (STSG). Clinically, the dermal template changed into well-vascularized neodermis, and after STSG, full take of the transplants was detected. No infections of the huge ACC areas were seen. Further studies must validate this treatment option in severe and acute cases of JEB-PA with ACC. Based on clinical findings, we postulate that placement of Integra®-Dermal Regeneration Template with STSG could be a new treatment option for patients having JEB-PA with ACC to prevent severe infection, compartment-syndrome-like conditions, and deformities. Based on literature findings, we assume that Integra®-Dermal Regeneration Template with STSG could even be able to prevent new blistering and thereby be a treatment option in cases of ACC and JEB.
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Affiliation(s)
- Julian Trah
- Department and Clinic of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christina Has
- Department of Dermatology, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg Im Breisgau, Germany
| | - Ingrid Hausser
- Heidelberg University Hospital, Institute of Pathology Heidelberg (IPH), Heidelberg, Germany
| | - Heinz Kutzner
- Dermatopathology Friedrichshafen, Friedrichshafen, Germany
| | - Konrad Reinshagen
- Department and Clinic of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ingo Königs
- Department and Clinic of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. .,Department of Pediatric Surgery, Burn Unit, Plastic and Reconstructive Surgery, Altonaer Children's Hospital, Bleickenallee 38, 22763, Hamburg, Germany.
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