Conservative Treatment of Cutis Aplasia

Aplasia Cutis Congenita of the Scalp, Composite Type: The Criticality and Inseparability of Neurosurgical and Plastic Surgical Management

“…Other threats to survival include thrombosis of the superior sagittal sinus [26], meningitis [25], sepsis [27], local infection [2,18,19,24,28], CSF leak [25,29,30], and hyponatremia [13,17]. Defects in the dura may also allow herniation or prolapse of the brain with mechanical injury to the parenchyma [3,25,29,30,31,32] and cerebral necrosis [17].…”

“…Defects in the dura may also allow herniation or prolapse of the brain with mechanical injury to the parenchyma [3,25,29,30,31,32] and cerebral necrosis [17]. Exposed venous sinuses and dura must be kept moist with saline-soaked sterile bandages for the few hours between birth and wound coverage.…”

“…Nonsurgical regimens reported for the management of aplasia cutis congenita, with varying degrees of success, have included the following: gauze dressings with continuous saline drips [33], adherent dressings [67], nonadherent dressings [68], bacitracin ointment [65], povidone-iodine [24], and Silvadene® (silver sulfadiazine) [18,29,37,45]. Silvadene is contraindicated in newborns under 2 months of age and should not be used in children with very large composite defects of the scalp [69].…”

Aplasia Cutis Congenita of the Scalp: Conservative Treatment After Failed Surgical Treatment (A Case and Review of Literature)

“…Historical mortality figures for aplasia cutis congenita range from 20 to 55 percent. These deaths were primarily a result of associated congenital defects or bleeding from the sagittal sinus secondary to surgical intervention or drying eschar and seperation (1,9). Treatment choices may be either conservative or operative.…”

“…The operative treatments include primary closure, skin grafting, local scalp flaps with or without tissue expansion, free flaps and cranial vault reconstruction using bone grafts. (1,10) Both conservative and operative managements are well accepted. The goal of conservative treatment is to allow granulation and healing by secondary intention whilst avoiding dessication and eschar formation.…”