Extensive Aplasia Cutis Congenita with Calvarial Defect and Superior Sagittal Sinus Exposure in a Term Neonate: A Case Report of Successful Healing with Conservative Management.

BACKGROUND: Aplasia cutis congenita (ACC) is a rare congenital disorder characterized by localized absence of skin, most commonly affecting the scalp. Extensive lesions involving the calvarium and dura, particularly when the superior sagittal sinus is exposed, are uncommon and may be complicated by hemorrhage, infection, thrombosis, neurological injury, and mortality. Management may be conservative or surgical and must be individualized according to defect size and depth, the structures exposed, the clinical condition of the neonate, and the resources and expertise available.

CASE PRESENTATION: We report a term male neonate with an approximately 4 × 4 cm midline frontoparietal scalp defect involving the skin and calvarium, with exposure of the superior sagittal sinus and underlying tissue. Brain computed tomography demonstrated a large congenital midline frontoparietal calvarial defect without a major intracranial abnormality. The neonate was clinically stable and was managed conservatively with intravenous ampicillin (50 mg/kg/dose every 12 hours during the first week), topical nitrofurazone and rifampicin, and twice-daily sterile saline-moistened gauze dressings. The available record did not document the concentration/formulation of the topical agents, specific nutritional supplementation, or a standardized parental home-care training protocol. Serial wound assessments demonstrated progressive granulation and epithelialization without documented local wound infection or systemic sepsis. After eight months of continued wound care, the lesion showed near-complete epithelialization with mature scar formation, residual crusting, and cicatricial alopecia.

CONCLUSION: This case demonstrates that conservative wound care can result in progressive closure in a clinically stable neonate with extensive ACC and calvarial defect with superior sagittal sinus exposure. The result should not be interpreted as evidence that conservative management is preferable to surgery in general. Instead, treatment should be individualized after assessment of bleeding, infection, depth of tissue loss, dural and venous-sinus exposure, neurological status, and the feasibility and risks of reconstruction. Close multidisciplinary monitoring and readiness to escalate to surgical coverage remain essential.