Clinical aspects of congenital skin defects

This paper is concerned with a review of 324 cases from the literature and an analysis of 7 personal cases of congenital defects of the skin of neonates. Single defects are 3 times as frequent as multiple and almost all are found within the region of hairy skin. Three quarters of all defects are in the median line or symmetrical to it. Two thirds of single scalp defects were smaller than 3 cm in diameter. There was a variety of shapes of the defects and the surface might be an open sore, granulating, all stages of epithelialization and even cicatrization so that every stage of healing was to be found at birth. Congenital defects of the scalp occured with the same frequency in female and male infants. The histological findings are summarized. Differential diagnosis should include trauma, congenital abscess of the scalp, encephalocele and meningocele. Healing depends on the extent of the size and depth of the defect. The principal complications are associated defects of the skull and hemorrhage from the eroded sagittal sinus. The time of greatest danger extends from the moment after birth to 8 days post partum. The mortality is 20%. Details of conservative and operative treatment are discussed.