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.