Moist wound healing theory in neonatal aplasia cutis congenita: a case report.

KEY MESSAGE: This clinical case demonstrates complete epithelialization of a neonatal scalp defect through staged application of moist wound dressings (silver, foam, hydrogel) that controlled inflammation, managed exudate, and promoted granulation, achieving rapid healing with minimal scarring.

BACKGROUND

Aplasia cutis congenita (ACC) is a rare developmental disorder with an estimated incidence of 0.5-1 per 10,000 live births. Currently, there is no standardized treatment protocol, especially for severe cases with potential skull exposure. The moist wound healing theory, which promotes cell migration and tissue regeneration by simulating physiological conditions, has recently demonstrated significant advantages in chronic wound management. This study presents a multidisciplinary approach to neonatal ACC management based on moist wound healing principles, providing novel insights for clinical practice.

CASE PRESENTATION: A male newborn of Han Chinese ethnicity, delivered at 38⁺5 weeks gestation with a birth weight of 2480 g (small-for-gestational-age), was admitted to the neonatology department 57 min after birth due to symmetrical full-thickness scalp defects. The defects measured 3.0 × 2.0 × 0.2 cm (length × width × depth), with a depressed wound base, no odor, no active bleeding, and intact skull. The Apgar scores were 10 at 1, 5, and 10 min, and laboratory findings were unremarkable. Based on classification criteria, the case was diagnosed as ACC Type II. The multidisciplinary team implemented a phased moist wound healing protocol, including antimicrobial moisturization, granulation tissue promotion, systemic support, and pain management. Complete epithelialization was achieved within 12 days without eschar formation, and no recurrence was observed at the 1-month follow-up.

CONCLUSIONS

This case demonstrates that a phased, multidisciplinary management strategy based on moist wound healing theory can effectively promote healing in neonatal ACC, avoiding the infection risks and secondary trauma associated with traditional dry eschar formation. The protocol significantly improved healing quality and the patient's treatment experience, highlighting its considerable potential for broad clinical adoption.