Challenges in the management of extensive aplasia cutis congenita

BMJ Case Rep. 2022 Feb 14;15(2):e246627. doi: 10.1136/bcr-2021-246627.

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.

Keywords: dermatology; neonatal and paediatric intensive care; plastic and reconstructive surgery.

Publication types

  • Case Reports

MeSH terms

  • Bandages
  • Child
  • Ectodermal Dysplasia* / diagnosis
  • Ectodermal Dysplasia* / therapy
  • Female
  • Hemorrhage
  • Humans
  • Infant
  • Scalp
  • Skin