Abstract
Introduction
Aplasia cutis congenita (ACC) is a rare congenital disorder. The purpose of this study was to present outcomes of tissue expander application for scalp reconstruction in extensive ACC.
Patient/Methods
In this retrospective study, medical records were reviewed for six patients who underwent serial tissue expander application for scalp reconstruction in ACC between 2000 and 2015. Patient average age was 14.5 (range, 4–25 years). One of the six cases had frontal bone defect, the others had bone and soft tissue defect at the vertex. In the newborn period, all patients have been managed by split-thickness skin grafts without cranioplasty procedures. After grafting and calvarial regeneration, one (or more) sessions of tissue expanders and scalp flap applications were performed for alopecia and soft tissue correction. Radiologic and clinical examination was performed for complications and outcomes.
Results
Computerized tomography showed intact calvarium with patchy hyperostosis in all patients. The mean size of grafted areas was 69.5 cm2 (range, 32–148.5 cm2). Minimal distal flap necrosis (6 × 1 cm) was observed in one patient. Serial scalp tissue expansion was performed with at least one session in a 1-year interval. One expander was extracted due to exposition and infection. No total flap losses and no calvarial defects were observed during follow-up (mean; 8.6 years). Clinical examination revealed acceptable cosmetic results in all patients.
Conclusion
We advocate late expander scalp reconstruction for management of extensive ACC cases.
Level of Evidence IV
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References
Loreti ABR, Selvaggi G et al (2004) Aplasia cutis congenita: report of four cases and literature review. Eur J Plast Surg 27:114–119
de Oliveira RS, Barros Juca CE, Lopes Lins-Neto A, do Carmo Rego MA, Farina J, Machado HR (2006) Aplasia cutis congenita of the scalp: is there a better treatment strategy? Child’s Nerv Syst 22(9):1072–1079
Maillet-Declerck M, Vinchon M, Guerreschi P, Pasquesoone L, Dhellemmes P, Duquennoy-Martinot V et al (2013) Aplasia cutis congenita: review of 29 cases and proposal of a therapeutic strategy. Eur J Pediatr Surg 23(2):89–93
Dutra LB, Pereira MD, Kreniski TM, Zanon N, Cavalheiro S, Ferreira LM (2009) Aplasia cutis congenita: management of a large skull defect with acrania. J Craniofac Surg 20(4):1288–1292
Beekmans SJ, don Griot JP, Niessen FB, Mulder JW (2009) Tissue expansion for correction of baldness in aplasia cutis congenita. Eur J Pediatr 168(5):541–544
Bharti G, Groves L, David LR, Sanger C, Argenta LC (2011) Aplasia cutis congenita: clinical management of a rare congenital anomaly. J Craniofac Surg 22(1):159–165
Silberstein E, Pagkalos VA, Landau D, Berezovsky AB, Krieger Y, Shoham Y et al (2014) Aplasia cutis congenita: clinical management and a new classification system. Plast Reconstr Surg 134(5):766e–774e
Trobs RB, Barenberg K, Hemminghaus M, Gunther M, Neid M (2010) Herniation of the brain after conservative treatment of a large congenital skull defect in an infant with Adams-Oliver syndrome. J Pediatr Surg 45(10):2064–2067
Ploplys EA, Muzaffar AR, Gruss JS, Ellenbogen RG (2005) Early composite cranioplasty in infants with severe aplasia cutis congenita: a report of two cases. Cleft Palate Craniofac J 42(4):442–447
Reddy S, Khalifian S, Flores JM, Bellamy J, Manson PN, Rodriguez ED et al (2014) Clinical outcomes in cranioplasty: risk factors and choice of reconstructive material. Plast Reconstr Surg 133(4):864–873
Liu Y, Qiu L, Fu Y, Tian X, Yuan X, Xiao J et al (2015) Large defects in aplasia cutis congenita treated by large-sized thin split-thickness skin grafting: long-term follow-up of 18 patients. Int J Dermatol 54(6):710–714
Smartt JM Jr, Kim EM, Tobias AM, Yan AC, Kirschner RE (2008) Aplasia cutis congenita with calvarial defects: a simplified management strategy using acellular dermal matrix. Plast Reconstr Surg 121(4):1224–1229
Koshy CE, Waterhouse N, Peterson D (2001) Large scalp and skull defects in aplasia cutis congenita. Br J Plast Surg 54(3):276–277
Beekmans SJ, Wiebe MJ (2001) Surgical treatment of aplasia cutis in the Adams-Oliver syndrome. J Craniofac Surg 12(6):569–572
Bajpai M, Pal K (2003) Aplasia cutis cerebri with partial acrania–total reconstruction in a severe case and review of the literature. J Pediatr Surg 38(2):e4
Aya R, Kawai K, Kawazoe T, Suzuki S (2014) A retrospective analysis on the proper size of tissue expanders to treat scalp lesions. Plast Reconstr Surg Glob Open 2(3):e118
Patel PA, Elhadi HM, Kitzmiller WJ, Billmire DA, Yakuboff KP (2014) Tissue expander complications in the pediatric burn patient: a 10-year follow-up. Ann Plast Surg 72(2):150–154
Bang RL, Ghoneim IE, Gang RK, Al Najjadah I (2003) Treatment dilemma: conservative versus surgery in cutis aplasia congenita. Eur J Pediatr Surg 13(2):125–129
Yang JY, Yang WG (2000) Large scalp and skull defect in aplasia cutis congenita. Br J Plast Surg 53(7):619–622
van Rappard JH, Molenaar J, van Doorn K, Sonneveld GJ, Borghouts JM (1988) Surface-area increase in tissue expansion. Plast Reconstr Surg 82(5):833–839
Theile RJ, Lanigan MW, McDermant GR (1995) Reconstruction of aplasia cutis congenita of the scalp by split rib cranioplasty and a free latissimus dorsi muscle flap in a nine month old infant. Br J Plast Surgery 48(7):507–510
Raposo-Amaral CE, Raposo-Amaral CA (2011) Aplasia cutis congenita: impact of early treatment on calvarial osteogenesis. J Plast Reconstr Aesthet Surg 64(9):e237–e240
Rhee ST, Colville C, Buchman SR, Muraszko K (2002) Complete osseous regeneration of a large skull defect in a patient with cutis aplasia: a conservative approach. J Craniofac Surg 13(4):497–500
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Gencel, E., Eser, C., Tabakan, I. et al. Outcomes of Tissue Expander Application for Scalp Reconstruction in Extensive Aplasia Cutis Congenita. Aesth Plast Surg 40, 114–119 (2016). https://doi.org/10.1007/s00266-015-0584-7
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DOI: https://doi.org/10.1007/s00266-015-0584-7