AM dressings are effective for newborn aplasia cutis congenita

The application of dressings made from amniotic membrane (AM) in newborn infants with aplasia cutis congenita (ACC) results in satisfactory cosmetic outcomes, with no hypertrophic scar formation, according to data from a study conducted in Iran.

Study participants were 5 neonates with a mean age of 3 days diagnosed with ACC who had a lesion (>1 cm2) or required skin grafting for survival. Practitioners used surgical debridement to remove necrotic tissue from the infants’ wounds, then applied an AM dressing and covered the wound with Vaseline gauze and an elastic bandage. They evaluated the wound through the transparent AM after 48 hours and, after each weekly assessment, re-dressed it with a new AM dressing. They repeated this cycle until the wound healed completely. The development of infection or sepsis led to a culture, intravenous antibiotics, and topical mupirocin.

Re-epithelialization was complete in all but 1 infant, without any severe fibrosis, hypertrophic scarring, or keloid formation. AM dressings resulted in an average re-epithelization time of 14 days for ulcers less than 5 cm2without any additional intervention. The average treatment duration for all 5 infants was 26 days.

Investigators noted that the process offers several advantages over conventional skin grafts. Dressing changes are less painful for neonates and minimize the risk of bleeding or oozing. In addition, complete wound coverage with the dressing helps prevent dehydration and heat loss. Finally, the procedure is less expensive than surgical intervention.

THOUGHTS FROM DR FARBER

I found this a fascinating and imaginative concept. Apparently, one can buy AMs commercially, and the procedure did not begin until day 3 or later, so if you have a surgeon willing to do this (it does not appear technically difficult), you should be good to go.

Reference:

Kadivar M, Sangsari R, Rostamli S, Sotoudeh S, Mirnia K. Amniotic membrane dressings for treatment of aplasia cutis in newborns. Pediatr Dermatol. 2024;41(3):445-450.