A Rare Case of Scalp Aplasia Cutis Congenita in a Zimbabwean Child

Abstract

Skull and scalp defects can be a challenge in the pediatric population. They predispose to meningitis and at times catastrophic exsanguination. Aplasia Cutis Congenita is a very rare condition resulting in a variable degree of absence of epidermis and dermis. It can be associated with skull defects especially the parietal vertex. We report a case managed at our hospital of a 2 week old Zimbabwean baby with a scalp and bi-parietal bone defect present at birth. He had no other congenital anomalies. Our case was managed by rotational pedicled flap to cover the skull defect. Various methods to close the skull defects have been highlighted in literature. These may include either split skin graft or full thickness graft especially if the pericranium is viable for nutritional support. Subgaleal scoring with flap advancement can also be employed by making longitudinal incisions perpendicular to the direction of advancement. Rotational flaps are especially useful in parieto-occipital lesions like our case. Patient factors for example size of defect, location and associated skull defects determine the optimal option to be used. Aplasia Cutis Congenita is therefore a rare condition which needs a multimodal approach. Lesions above 2 cm in greatest diameter and associated skull defects should have early surgery to avoid complications like infections and hemorrhage.