Skip to content
Inciteful Med

Treating ACC: Wound Care and Surgery

Last updated:

For most newborns with Aplasia Cutis Congenita (ACC), conservative wound care is the preferred treatment over surgery. By using specialized dressings and ointments, the baby's body can naturally heal the missing skin, avoiding surgical risks.

Key Takeaways

  • • Conservative management using specialized wound dressings is the standard of care for most Aplasia Cutis Congenita cases.
  • • Topical treatments like bland emollients, hydrocolloid dressings, and medical honey help create a moist environment for natural healing.
  • • Bathing around the defect is generally safe once the area is stable, provided the tissue is washed gently and patted dry.
  • • Surgery is rarely required unless there is severe bleeding, failure to heal, or exposure of the brain or major veins.
  • • Complex ACC cases should be managed by a multidisciplinary team including pediatric dermatologists, plastic surgeons, and neurosurgeons.

When it comes to treating Aplasia Cutis Congenita (ACC), the most important thing for parents to understand is that “less is often more.” For the vast majority of cases—even some very large ones—doctors prefer a non-surgical approach called conservative management [1][2][3].

Why Conservative Care is the Standard

Conservative management is the preferred standard of care because the newborn body has a remarkable ability to heal itself. By using specialized dressings and topical treatments, doctors can provide the environment needed for the skin to naturally close over the defect [4][5].

This approach is preferred over surgery for several reasons:

  • Lower Risk: Surgery in newborns carries risks from anesthesia and potential infection [2][6].
  • Natural Healing: Conservative care allows the wound to fill in with the baby’s own tissue (a process called re-epithelialization) [5][7].
  • Effective Even for Large Defects: Research shows that even large scalp and bone defects can often heal completely with just careful wound care, avoiding the need for complex reconstructive surgery [8][2].

Common Topical Treatments and Dressings

Your care team will select a dressing based on the size, location, and moisture level of the wound. Common options include:

  • Bland Emollients and Ointments: Products like plain petrolatum (Vaseline or Aquaphor) or mupirocin ointment are frequently used to keep the wound moist and prevent infection without irritating a newborn’s delicate skin [5][2].
  • Hydrocolloid Dressings: These create a protective, moist environment that promotes the growth of new skin cells [7][2].
  • Medical Grade Honey (ALH): Specialized honey has been used successfully to promote closure in large ACC lesions without the need for systemic antibiotics [4].
  • Growth Factors: In some cases, gels containing human growth factors are used to “jump-start” the healing process in stubborn wounds [7][9].
  • Amniotic Membrane: Biological dressings made from amniotic tissue can speed up healing and lead to a smoother scar [10].

Bathing and Basic Hygiene

Parents are often terrified to wash their baby’s head near the defect. Your doctor will provide specific instructions, but generally, once the area is stable, you can gently cleanse around the wound with warm water and mild baby shampoo. Never scrub the healing tissue, and always gently pat the area completely dry [10].

When is Surgery Necessary?

While rare, surgical intervention (such as skin grafts or flaps) is reserved for high-risk or life-threatening situations [11][2]. Surgery may be absolutely necessary if:

  1. Critical Exposure: The protective layers over the brain or the superior sagittal sinus (a major vein) are missing, leaving them vulnerable to injury [12][3].
  2. Severe Bleeding: There is active, life-threatening hemorrhage that cannot be controlled with pressure [12].
  3. Failure to Heal: The wound does not show signs of closing despite several weeks of expert conservative care [11].

Building the Care Team

For complex cases, especially those involving the scalp or other syndromes, your baby should be followed by a multidisciplinary team [13][14]. This team typically includes:

  • Pediatric Dermatologist: The expert in skin healing and topical treatments.
  • Pediatric Plastic Surgeon: Consulted if the wound is very large or if surgical closure might be needed later.
  • Pediatric Neurosurgeon: Essential if there is any concern about underlying bone or brain involvement [15].
  • Pediatrician: To coordinate overall health and monitor for developmental milestones.
  • Geneticist: Consulted if the ACC is part of a syndrome like Adams-Oliver or Bart syndrome [16][17].

By bringing these specialists together, you ensure that every aspect of your baby’s condition—from the surface of the skin to the health of the underlying brain—is being expertly monitored [18]. For what happens after the wound is healed, see The Long-Term Outlook for Your Child.

Frequently Asked Questions

Why is conservative management usually the best treatment for ACC?
Doctors prefer conservative wound care because a newborn's body has a remarkable ability to heal naturally. Using specialized dressings avoids the risks of anesthesia and surgery while allowing the skin to close over the defect on its own.
How do I bathe a baby with aplasia cutis congenita?
Once the wound is stable and your doctor gives approval, you can gently wash around the area with warm water and mild baby shampoo. Never scrub the healing tissue, and always pat the area completely dry.
When is surgery necessary for an ACC scalp defect?
Surgery is rare but may be needed for high-risk situations like severe bleeding or failure to heal after weeks of wound care. It is also necessary if protective layers over the brain or major blood vessels are missing.
What kinds of dressings are used to treat ACC wounds?
Doctors use various treatments depending on the wound's size and moisture level. Common options include plain ointments like plain petrolatum, hydrocolloid dressings, medical-grade honey, and sometimes biological dressings like amniotic membrane.
What specialists should be on my baby's ACC care team?
Complex cases are best managed by a team of pediatric specialists. This typically includes a pediatric dermatologist, pediatric plastic surgeon, pediatric neurosurgeon, pediatrician, and sometimes a geneticist.

Questions for Your Doctor

  • • Why is conservative management the best choice for my baby's specific lesion?
  • • Who is the 'lead' coordinator on our multidisciplinary team?
  • • What is our 'plan B' if the wound doesn't show signs of healing within a few weeks?
  • • How much experience does this team have with large scalp defects or syndromic ACC (like Adams-Oliver)?
  • • Are there specific signs of superior sagittal sinus exposure we should be checking for during dressing changes?

Questions for You

  • • Do I have a clear, written schedule for when to change the dressings and what medications to apply?
  • • Do I have the contact information for a specialist to call if I notice any unexpected bleeding or discharge?
  • • Am I comfortable with the current plan, or do I feel we need a second opinion from a larger pediatric center?

Want personalized information?

Type your question below to get evidence-based answers tailored to your situation.

References

  1. 1

    Nonsyndromic aplasia cutis congenita: a case report.

    Chokoeva AA, Tchernev G, Patterson JW, et al.

    Journal of biological regulators and homeostatic agents 2015; (29(1 Suppl)):129-31.

    PMID: 26016981
  2. 2

    A rare case of aplasia cutis congenita.

    Chen Z, Ning J

    Asian journal of surgery 2023; (46(11)):4848-4849 doi:10.1016/j.asjsur.2023.05.131.

    PMID: 37308381
  3. 3

    APLASIA CUTIS CONGENITA TYPE I - A CASE SERIES.

    Wollina U, Chokoeva A, Verma S, et al.

    Georgian medical news 2017; 7-11.

    PMID: 28480840
  4. 4

    Topical Leptospermum Honey in the Management of Aplasia Cutis Congenita in Neonates: A Case Study.

    Boyar V

    Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society 2019; (46(4)):343-345 doi:10.1097/WON.0000000000000541.

    PMID: 31276452
  5. 5

    Aplasia cutis congenita of the trunk in a newborn: a rare case report.

    Ahmed EM, Najoua A, Salma F, et al.

    The Pan African medical journal 2024; (48()):52 doi:10.11604/pamj.2024.48.52.43784.

    PMID: 39315062
  6. 6

    [Aplasia cutis congenita].

    Steinbacher J, Rath T, Tzou CH

    Handchirurgie, Mikrochirurgie, plastische Chirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Handchirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Mikrochirurgie der Peripheren Nerven und Gefasse : Organ der V... 2016; (48(4)):239-43 doi:10.1055/s-0042-103155.

    PMID: 27547933
  7. 7

    A Case Series of Aplasia Cutis Congenita and Its Management.

    Khatija Begum M, Vijayashree J, Bathina A, Gullipalli P

    Cureus 2025; (17(3)):e80135 doi:10.7759/cureus.80135.

    PMID: 40190843
  8. 8

    Large aplasia cutis congenita of the vertex conservative management.

    Bouali S, Charfeddine SH, Ghedira K, et al.

    Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery 2024; (40(2)):285-292 doi:10.1007/s00381-023-06190-x.

    PMID: 37865964
  9. 9

    Conservative Treatment of Large Aplasia Cutis Congenita of the Scalp With Bone Defect With Basic Fibroblast Growth Factor Application.

    Orgun D, Horiguchi M, Hayashi A, et al.

    The Journal of craniofacial surgery 2017; (28(2)):e154-e158 doi:10.1097/SCS.0000000000003347.

    PMID: 28045831
  10. 10

    Amniotic membrane dressings for treatment of aplasia cutis in newborns.

    Kadivar M, Sangsari R, Rostamli S, et al.

    Pediatric dermatology 2024; (41(3)):445-450 doi:10.1111/pde.15540.

    PMID: 38409959
  11. 11

    [Aplasia cutis congenita: Update and management].

    Belkhou A, François C, Bennis Y, et al.

    Annales de chirurgie plastique et esthetique 2016; (61(5)):450-461 doi:10.1016/j.anplas.2016.07.003.

    PMID: 27503278
  12. 12

    Aplasia cutis congenita scalp presenting with life threatening hemorrhage: a case report.

    Mahmood F, Tasneem S, Nadeem MM

    Journal of neonatal surgery 2012; (1(1)):8.

    PMID: 26023367
  13. 13

    Aplasia Cutis Congenita and Congenital Heart Disease: A Case Report, Highlighting the Limitation of Antenatal Screening.

    Halawani LK

    The American journal of case reports 2026; (27()):e950665 doi:10.12659/AJCR.950665.

    PMID: 41477812
  14. 14

    Adams-Oliver Syndrome in a Newborn: A Case Report and Comprehensive Literature Review.

    N'joumi C, Ayyad A, Messaoudi S, Amrani R

    Cureus 2025; (17(6)):e86442 doi:10.7759/cureus.86442.

    PMID: 40689001
  15. 15

    Low risk of clinically important central nervous system dysraphism in a cohort study of 69 patients with isolated aplasia cutis congenita of the head.

    Kuemmet TJ, Miller JJ, Michalik D, et al.

    Pediatric dermatology 2020; (37(3)):455-460 doi:10.1111/pde.14117.

    PMID: 32053222
  16. 16

    Aplasia cutis congenita: a report of two cases from National Hospital Abuja, Nigeria and review of the literature.

    Mukhtar-Yola M, Mshelia L, Mairami AB, et al.

    The Pan African medical journal 2020; (36()):291 doi:10.11604/pamj.2020.36.291.24523.

    PMID: 33117485
  17. 17

    Bart Syndrome: A Case with Extensive Skin Lesions and Multiple Congenital Anomalies in a Preterm Neonate.

    Alwafi D, Aldoboke A, Nukaly HY, Alwafi H

    Case reports in dermatology 2025; (17(1)):416-421 doi:10.1159/000547618.

    PMID: 41064305
  18. 18

    Surgical management of aplasia cutis congenita of the scalp and skull defect in a resource-limited setting: A case report.

    Agyekum R, Darko K, Odame NYA, et al.

    Surgical neurology international 2026; (17()):46 doi:10.25259/SNI_1245_2025.

    PMID: 41660340

This page provides educational information about ACC wound care and surgical options. Always consult your pediatric care team for specific treatment recommendations and wound care instructions for your baby.

Stay up to date

Get notified when new research about Aplasia cutis congenita is published.

No spam. Unsubscribe anytime.