Non-surgical management of severe aplasia cutis congenital accompanied by a bone defect – a case study

Abstract

Background and objectives. Aplasia cutis congenita (ACC) is a rare developmental disorder that is not fully understood. It is part of a diverse group of conditions characterized by the congenital absence of THE epidermis, dermis, and occasionally subcutaneous tissues or bone, often affecting the crown of the scalp. It frequently presents as an isolated condition but can also be associated with a syndrome. Among patients, scalp involvement is common; however, large scalp defects with skull involvement are uncommon. Materials and methods. We report the case of a newborn delivered at full term by cesarean section, 3200g, in Mangalia Municipal Hospital, later transferred to the Constanta Neonatology Department, Neonatal Intensive Care department, for 3 injuries with lack of substance, both in tegument and bone, of different sizes, at the level of the vertex and the occiput. Results. Given the fragile age, a conservative management approach was chosen. The wound was meticulously cleaned daily using sterile water, and a self-adhesive absorbent dressing with hydrocolloid was applied. This dressing promoted granulation and epithelialization, adjusting dynamically to the lesion size. The newborn remained hospitalized for 35 days until the closure of the most extensive skin lesion at the vertex. Conclusions. Aplasia cutis congenita can be managed using various treatment approaches, but a consensus on the optimal strategy remains elusive. While conservative treatment has been proposed, several authors have highlighted its limitations. The choice between conservative and surgical management should be personalized, considering factors such as lesion size, location, underlying etiology, and related abnormalities.