4.3 Treatment
Currently, there are two classification systems commonly used for ACC,
namely the Sybert classification system and the Frieden classification
system[10]. The Sybert classification system
classifies ACC into six subtypes based on defect location and
concomitant symptoms. However, it does not mention the complementary
treatment and prognosis. Frieden further analyzes the associated
abnormal manifestations of ACC, provides insight into the genetic
pattern, and emphasizes the associated pathogenesis. The treatment of
patients with ACC depends on the lesion’s size and the presence of
underlying defects. For small lesions (less than 2 cm) with no
additional findings, daily cleaning of the lesion with topical
antimicrobial ointment is recommended until healing is complete. Lesions
will usually heal within a few weeks to a few months, leaving an
atrophic, hairless scar. More extensive lesions (greater than 4 cm) are
more commonly combined with underlying defects and have an increased
risk of complications, including bleeding, venous thrombosis, and
infection[11]. Early surgical repair with either a
skin graft or a flap repair technique is recommended to avoid these
complications[11]. For lesions between 2-4 cm,
conservative treatment is an option and surgical treatment. Conservative
treatment includes applying various dressings, continuous rehydration,
topical antimicrobial agents, and systemic antibiotics to promote
spontaneous epithelialization. Conservative treatment should first be
performed in a neonatal intensive care unit with the right monitoring
conditions, and then the child can be cared for at home once the
condition is stabilized[11]. The advantages of
conservative treatment are that it avoids the risks associated with
surgery and complications in the donor area. The disadvantages are that
it may cause hemorrhage, meningitis, and loss of body fluids from the
wound leading to hyponatremia causing brain herniation and seizures.
Surgical treatment of congenital scalp defects includes simple
debridement and suturing, flap transfer, autologous or allogeneic skin
grafting, early or delayed cranioplasty, and tissue expansion. Although
the literature reports that cranial defects can be rapidly regenerated,
most scholars recommend repairing the skin along with the cranial defect
for optimal results[3-5, 7, 8]. The surgical
treatment complications are mainly due to general anesthesia for
tracheal intubation of neonates and the inherent high risk of complex
surgical operations[9]. With medical technology
advancements, surgical complications are relatively low, and most of
them can be effectively controlled. Compared with conservative
treatment, children who underwent surgery had a significantly shorter
healing time and fewer postoperative complications. In this report, two
children, one treated surgically and one treated conservatively, had
good healing of the scalp defect without local or systemic
complications.