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Its treatment varies according to the size and localisation of the defect and the degree of involvement of adjacent structures&#46; Early treatment is recommended to prevent complications such as sagittal sinus haemorrhage&#44; infection&#44; fluid and electrolyte imbalances&#44; or thermal imbalances&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The aim of this study was to describe the clinical and epidemiological characteristics of ACC&#44; as well as our experience in its management&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">We conducted a descriptive and retrospective study by reviewing the medical records of patients with ACC aged less than 14 years that were treated in our department between January 2000 and December 2013&#46; We included every patient with a presurgical diagnosis compatible with ACC&#46; We excluded patients with lesions in which the microscopic findings of the histological examination were incompatible with ACC&#46; We performed a descriptive analysis of the variables based on their distribution and using measures of central tendency&#44; assessing the associations between the treatment used&#44; the size of the lesion&#44; the development of postoperative complications&#44; the length of stay and the need for reoperation&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Conservative management of patients included daily local therapy with topical silver sulfadiazine 1&#37; or nitrofurazone 0&#46;2&#37; and application of an occlusive dressing until secondary-intention healing was complete&#46; Several approaches were used for surgical management&#44; including excision and primary closure of the defect&#44; full-thickness skin grafting&#44; split-thickness grafting following the previous implantation of biosynthetic primate acellular matrix or bilayer matrix products&#44; and rotation or advancement flaps&#44; with or without the use of tissue expanders&#46; The surgeon in charge determined whether a conservative or surgical approach was indicated&#46; This decision was made based on lesion size&#44; bone involvement and the medical condition of the patient&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Whenever biological samples were obtained&#44; they were sent for histopathological examination&#44; and whenever a patient died&#44; an autopsy was performed to determine the cause&#46; In cases in which biological samples were not obtained&#44; the diagnosis was made based on the clinical manifestations&#46; Patients were followed up in the outpatient clinics to monitor the surgical wound or skin lesion and assess for comorbidities&#44; postoperatory complications and cosmetic outcomes&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0035" class="elsevierStylePara elsevierViewall">We reviewed the records of 23 patients that received an initial diagnosis of ACC&#44; 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7&#46;07<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>&#41; in both hands&#44; and 2<span class="elsevierStyleHsp" style=""></span>cm in diameter on the back of both hands and both legs&#46; The lesions in the patient with systemic involvement were large&#44; and affected approximately 20&#37; of the total body surface area&#44; especially the torso and the upper limbs&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Five patients with ACC in the scalp had associated diseases that included&#58; heart disease with ventricular septal defect&#44; duplex collecting system&#44; complete cleft palate with Pierre-Robin sequence&#44; Adams-Oliver syndrome&#44; and one girl with multiple malformations&#46; The other patients had dystrophic epidermolysis bullosa&#44; Streeter dysplasia and Bart syndrome&#46; Genetic testing was performed in only two patients&#44; and did not detect chromosomal abnormalities in either&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Scalp lesions were managed with conservative treatment in seven patients &#40;36&#46;3&#37;&#41;&#44; all of whom had lesions smaller than 4<span class="elsevierStyleHsp" style=""></span>cm &#40;12&#46;57<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>&#41;&#44; except for one lesion with a 9<span class="elsevierStyleHsp" style=""></span>cm diameter &#40;area&#44; 63&#46;62<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>&#41; that was managed conservatively due to high anaesthetic and surgical risk&#46; The rest of the patients were treated with surgery &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; The patient with a lesion of 14<span class="elsevierStyleHsp" style=""></span>cm &#40;154<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>&#41;&#44; with an associated bony defect of similar size underwent implantation of a biosynthetic matrix &#40;INTEGRA<span class="elsevierStyleSup">&#174;</span> Matrix Wound Dressing&#44; Integra LifeSciences Corporation&#44; Plainsboro&#44; New Jersey&#44; USA&#41; followed by a split-thickness graft to cover the defect&#46; The second patient with a large bony defect underwent primary closure of the scalp with no additional treatment on the bone&#44; and responded favourably&#46; The other two patients that had bony defects were managed conservatively&#44; and showed good bone development and closure of the defect&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Of the four patients that had lesions in the extremities&#44; two underwent surgery&#46; In one&#44; several full-thickness grafts were inserted in the lesions of the hands&#44; and a series of plastic surgeries were performed on the patient that had the lesion in the finger&#46; A biopsy was performed on the patient that had lesions on the hands and feet&#44; confirming the ACC diagnosis&#59; conservative management was chosen for this patient&#46; The patient with torso involvement received conservative treatment&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The median length of stay was less than 1 day &#40;IQR&#44; 0&#46;5&#8211;7&#41;&#44; with a maximum of 25 days&#59; patients were followed up for a median of 2 years and 7 months&#46; Two patients died in our study &#40;9&#46;52&#37;&#41;&#59; the first was a newborn girl aged 11 days with a polymalformative syndrome with complex heart disease that developed heart failure and a low-output intestinal fistula&#59; the second was a patient with Bart syndrome that died from haemodynamic decompensation resulting from the large size of the epidermolysis bullosa lesions&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">Aplasia cutis congenita is a rare disease characterised by the localised absence of skin&#44; and its incidence rate is of 1&#8211;3 per 10<span class="elsevierStyleHsp" style=""></span>000 live births per year&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">3&#44;4</span></a> Its specific causes are not known&#44; although it is assumed that the lesion develops <span class="elsevierStyleItalic">in utero</span> due to abnormal ectodermal development in the embryonic period secondary to a mechanical&#44; vascular&#44; teratogenic or hereditary disturbance&#44; unrelated to the delivery or first hours post birth&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">5</span></a> It has been described in association with isolated malformations such as patent ductus arteriosus&#44; tracheoesophageal fistula&#44; epidermolysis bullosa&#44; limb malformations&#44; cleft lip and palate&#44; and kidney malformations&#44; among others&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">6&#44;7</span></a> In our series&#44; 22&#37; of the patients had associated congenital malformations&#44; including one case of Adams-Oliver&#44; one of Streeter dysplasia and one of Bart syndrome&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Ultrasound examination in the last weeks of gestation may lead to prenatal suspicion of ACC&#44;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">8</span></a> although the condition is diagnosed by examination of the newborn&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">9</span></a> In our series&#44; 47&#46;5&#37; of the patients were referred to our clinic more than four months post birth&#44; even though the initial diagnosis had been made in the neonatal period&#46; We believe that an evaluation should be performed and an individualised treatment plan developed immediately after diagnosis&#46; If the diagnosis is uncertain&#44; a biopsy of the lesion could be performed to rule out other dermatoses&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">10</span></a> Additional testing is recommended to rule out associated anomalies&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">6</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Mortality due to haemorrhage&#44; sagittal sinus thrombosis or central nervous system infection can reach up to 50&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">2&#44;10&#44;11</span></a> Mortality is associated with larger lesion sizes and underlying bony defects&#46; Therefore&#44; treatment must be geared towards the prevention of these complications&#46; In our experience&#44; mortality was not associated with ACC complications&#44; but to complications of associated pathologies&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The typical presentation consists of a solitary lesion localised to the scalp vertex&#44; oval in shape&#44; well demarcated&#44; hairless&#44; with the longest diameter ranging between 1 and 3<span class="elsevierStyleHsp" style=""></span>cm &#40;area&#44; 0&#46;79&#8211;7&#46;07<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>&#41;&#44; and the appearance of scar or granulation tissue&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">10&#44;12</span></a> Seventy to ninety percent of cases involve the scalp&#44; and up to thirty percent are associated with bony defects&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">13</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">There is great controversy surrounding the treatment of ACC&#44; and there is no consensus as to the treatment approach or type of intervention that should be implemented&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">2</span></a> In our experience&#44; there are limited possibilities for adequate closure of the scalp due to its low elasticity&#44; restricted mobility&#44; spherical shape requiring longer skin flaps and limited tissue availability due to the need for preserving axial blood flow&#46; Therefore&#44; the therapeutic approach must be based on the size of the lesion and the presence or absence of underlying cranial defects&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">9&#44;14</span></a> Tissue specimens obtained during surgery should be submitted for histopathological examination to rule out other dermatoses&#44; including nevus sebaceous&#44; traumatic scarring&#44; scarring alopecia&#44; epidermolysis bullosa&#44; localised infection&#44; congenital dermoid cysts&#44; cutaneous meningioma and heterotopic brain tissue&#44; among others&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">10</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Lesions with a diameter of less than 2<span class="elsevierStyleHsp" style=""></span>cm &#40;area&#44; 3&#46;14<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>&#41; and no osseous involvement can be treated conservatively&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">2&#44;15</span></a> The cosmetic outcomes are good&#44; the risk of complications is low&#44; and anaesthesia is not required&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">16</span></a> Another possibility is to perform a radical excision of the lesion under local anaesthesia and sedation&#44; followed by primary closure&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Defects between 2 and 4<span class="elsevierStyleHsp" style=""></span>cm in diameter &#40;area&#44; 3&#46;14&#8211;12&#46;57<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>&#41; can be managed conservatively&#44;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">17</span></a> although primary closure of the defect is preferred if the defect is larger than 2<span class="elsevierStyleHsp" style=""></span>cm and with exposed bone&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">In cases involving lesions larger than 4<span class="elsevierStyleHsp" style=""></span>cm or bony defects&#44; the conservative approach is not recommended due to the risk of complications&#44; poor cosmetic outcomes and the need for longer hospitalisations&#46; Among the surgical options that have been described in the literature&#44;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">11</span></a> the one we performed most often was primary closure in a single or a series of surgeries&#46; Treatment with skin grafts&#44; dermal substitutes and skin flaps yielded good results and has been described extensively in other published case series&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">2&#44;6&#44;14</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Surgical treatment is preferred in cases associated with bony defects&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">11</span></a> The use of skin flaps has been described in the literature&#44; and this technique has shown very good outcomes and an associated decrease in the risk of complications&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">5&#44;6&#44;14</span></a> Other options include full-thickness grafts&#44; split-thickness grafts and tissue expansion&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">18</span></a> There have also been reports of the use&#44; with favourable outcomes&#44; of allografts&#44;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">19</span></a> acellular dermal grafts and cultured keratinocyte grafts&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">20</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Lesions in the torso or extremities may be managed conservatively&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">21</span></a> If the lesion is very large or it involves a joint&#44; surgical treatment with skin grafts or plastic surgery is recommended to avoid functional limitations or very large scars&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Complications following conservative or surgical treatment may include hypertrophic scarring and keloids with or without cicatricial alopecia and secondary infection of the wound&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">2&#44;10</span></a> In our case series&#44; the most frequent complication was scarring&#44; and it usually did not require additional surgeries&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">A broad range of therapeutic approaches are still being used for ACC&#46; Due to the characteristics of this study&#44; we were unable to determine which treatment is best for ACC&#44; but surgical management is usually preferred&#44; especially for larger lesions&#44; as it can prevent fatal complications and the cosmetic results are good&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusions</span><p id="par0130" class="elsevierStylePara elsevierViewall">We believe that ACC is a disease that carries the risk of potentially fatal complications&#44; but that these can be prevented with appropriate treatment&#46; While conservative management is an option&#44; we favour surgery as long as it can be performed on the patient&#46; Surgery&#44; regardless of which technique is used&#44; must be performed with the goal of closing the skin defect&#44; and should be considered especially for lesions more than 4<span class="elsevierStyleHsp" style=""></span>cm in diameter or with associated bony defects&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflicts of interest</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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    "fechaRecibido" => "2014-09-18"
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            0 => "Aplasia cutis"
            1 => "Vertex"
            2 => "Skin flaps"
            3 => "Skin grafts"
            4 => "Bart&#39;s syndrome"
            5 => "Adams-Oliver&#39;s syndrome"
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            0 => "Aplasia cutis cong&#233;nita"
            1 => "V&#233;rtex"
            2 => "Colgajos cut&#225;neos"
            3 => "Injertos cut&#225;neos"
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    "resumen" => array:2 [
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Aplasia cutis congenita &#40;ACC&#41; is a rare congenital malformation that commonly involves the scalp&#44; but can affect pericranium&#44; bone and dura mater&#46; Complications are rare&#44; but can be fatal&#44; so early treatment must be achieved&#46; The treatment remains controversial with no consensus between the conservative and surgical approach&#46; The aim of this study is to describe our experience in the management of ACC&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Retrospective review of the medical records of all children up to 14 years diagnosed with ACC and treated between 2000 and 2013&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">There were a total of 22 cases of ACC with lesions ranging from 1<span class="elsevierStyleHsp" style=""></span>cm &#40;0&#46;79<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>&#41; to 14<span class="elsevierStyleHsp" style=""></span>cm &#40;153&#46;94<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>&#41;&#46; ACC of the scalp was found in 18 cases&#44; with 3 in extremities and 1 in trunk&#46; Conservative treatment was performed on 9 patients and 13 underwent surgical treatment &#40;8 primary closures&#44; 2 plasties&#44; 2 skin grafts&#44; and 1 skin flap&#41;&#46; Two patients died due to complications of other diseases not related with the ACC&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">ACC is a rare disease that can be fatal&#46; A complete initial assessment to establish early treatment is necessary to prevent this&#46; Surgery should be considered as an initial therapeutic option in defects &#62;4<span class="elsevierStyleHsp" style=""></span>cm &#40;&#62;12&#46;6<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>&#41; as it prevents the risk of fatal complications&#46;</p></span>"
        "secciones" => array:4 [
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            "titulo" => "Introduction"
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            "titulo" => "Materials and methods"
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      "es" => array:3 [
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La aplasia cutis cong&#233;nita &#40;ACC&#41; es una malformaci&#243;n cong&#233;nita rara que afecta sobre todo al cuero cabelludo&#44; aunque puede afectar al pericr&#225;neo&#44; el cr&#225;neo y la meninges&#46; Las complicaciones pueden llegar a ser fatales&#44; por lo que es necesario un tratamiento oportuno&#46; El tratamiento sigue siendo controvertido&#44; sin encontrar un consenso entre el abordaje conservador y el quir&#250;rgico&#46; El <span class="elsevierStyleItalic">objetivo</span> de este estudio es describir nuestra experiencia en el manejo de la ACC&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio descriptivo retrospectivo de las historias cl&#237;nicas de los pacientes menores de 14 a&#241;os con diagn&#243;stico de ACC&#44; atendidos entre el a&#241;o 2000 y el 2013&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Veintid&#243;s casos de ACC con lesiones que variaban de 1<span class="elsevierStyleHsp" style=""></span>cm &#40;0&#44;79<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>&#41; a 14<span class="elsevierStyleHsp" style=""></span>cm &#40;153&#44;94<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>&#41;&#46; Dieciocho casos presentaron lesiones en el cuero cabelludo&#44; 3 en extremidades y uno en tronco&#46; Se realiz&#243; tratamiento conservador en 9 y quir&#250;rgico en 13 &#40;8 cierres primarios&#44; 2 plastias&#44; 2 injertos cut&#225;neos y un colgajo&#41;&#46; Dos pacientes fallecieron por complicaciones de otras patolog&#237;as no asociadas a la ACC&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La ACC es infrecuente y puede tener un desenlace fatal&#46; Para prevenirla es necesaria una evaluaci&#243;n inicial completa para establecer un tratamiento oportuno&#46; La cirug&#237;a es una buena opci&#243;n terap&#233;utica&#44; sobre todo en defectos con di&#225;metro<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>cm &#40;12&#44;6<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>&#41;&#44; ya que disminuye el riesgo de complicaciones mortales&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as&#58; Betancourth-Alvarenga JE&#44; V&#225;zquez-Rueda F&#44; Vargas-Cruz V&#44; Paredes-Esteban RM&#44; Ayala-Montoro J&#46; Manejo quir&#250;rgico de la aplasia cutis cong&#233;nita&#46; An Pediatr &#40;Barc&#41;&#46; 2015&#59;83&#58;341&#8211;345&#46;</p>"
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          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">IQR&#44; interquartile range&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Conservative treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Surgical treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Sex&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;31&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;36&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;68&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;9&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;22&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;31&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">Age in months&#44; median &#40;IQR&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;0&#8211;78&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;0&#8211;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Localisation of lesion&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Scalp</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;31&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;50&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;81&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Vertex</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;18&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;31&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#40;50&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Parietal</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;9&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;9&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Occipital</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;9&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;13&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Temporal</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Frontal</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Extremities</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;9&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;13&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Torso</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">Bony defect&#44;</span><span class="elsevierStyleItalic"><span class="elsevierStyleBold">n</span></span><span class="elsevierStyleBold">&#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;9&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;9&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;18&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Complications&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Scar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;9&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;36&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;45&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Death<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;9&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;9&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">Length of stay in days&#44; median &#40;IQR&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;1&#8211;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#8211;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#8211;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">Reoperation&#44;</span><span class="elsevierStyleItalic"><span class="elsevierStyleBold">n</span></span><span class="elsevierStyleBold">&#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;31&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;36&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#60;2<span class="elsevierStyleHsp" style=""></span>cm <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2&#8211;4<span class="elsevierStyleHsp" style=""></span>cm <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#62; 4<span class="elsevierStyleHsp" style=""></span>cm <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Conservative</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;13&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;22&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;40&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Surgical</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;31&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;27&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13 &#40;59&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Primary closure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;18&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;18&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;36&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Graft&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;9&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Skin flap&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Plastic surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;9&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;9&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Bony defect</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;9&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;18&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Complications</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Scar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;18&#8211;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;45&#8211;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Infection&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;36&#8211;4&#41;&nbsp;\t\t\t\t\t\t\n
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Original Article
Surgical management of aplasia cutis congenita
Manejo quirúrgico de la aplasia cutis congénita
J.E. Betancourth-Alvarengaa,
Corresponding author
josue185@gmail.com

Corresponding author.
, F. Vázquez-Ruedaa,b, V. Vargas-Cruza, R.M. Paredes-Estebana, J. Ayala-Montoroa
a Unidad de Gestión Clínica de Cirugía Pediátrica, Hospital Universitario Reina Sofía, Córdoba, Spain
b Facultad de Medicina Universidad de Córdoba, Córdoba Spain
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    "titulo" => "Surgical management of aplasia cutis congenita"
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        "titulo" => "Manejo quir&#250;rgico de la aplasia cutis cong&#233;nita"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Aplasia cutis congenita &#40;ACC&#41; is a malformation consisting of the congenital absence of skin in certain areas&#46; It most commonly involves the scalp&#44; with a depth confined to the epidermis or dermis&#44; and the appearance of a scar or ulcer&#46; Its aetiology is unknown&#44; although there are multiple biological&#44; pharmacological&#44; mechanical and genetic factors that could contribute to its aetiopathogenesis&#46; A pattern of genetic inheritance has been described in some cases&#44; in which ACC was associated to other congenital defects&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The diagnosis is usually made when the newborn is first examined&#46; Its treatment varies according to the size and localisation of the defect and the degree of involvement of adjacent structures&#46; Early treatment is recommended to prevent complications such as sagittal sinus haemorrhage&#44; infection&#44; fluid and electrolyte imbalances&#44; or thermal imbalances&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The aim of this study was to describe the clinical and epidemiological characteristics of ACC&#44; as well as our experience in its management&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">We conducted a descriptive and retrospective study by reviewing the medical records of patients with ACC aged less than 14 years that were treated in our department between January 2000 and December 2013&#46; We included every patient with a presurgical diagnosis compatible with ACC&#46; We excluded patients with lesions in which the microscopic findings of the histological examination were incompatible with ACC&#46; We performed a descriptive analysis of the variables based on their distribution and using measures of central tendency&#44; assessing the associations between the treatment used&#44; the size of the lesion&#44; the development of postoperative complications&#44; the length of stay and the need for reoperation&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Conservative management of patients included daily local therapy with topical silver sulfadiazine 1&#37; or nitrofurazone 0&#46;2&#37; and application of an occlusive dressing until secondary-intention healing was complete&#46; Several approaches were used for surgical management&#44; including excision and primary closure of the defect&#44; full-thickness skin grafting&#44; split-thickness grafting following the previous implantation of biosynthetic primate acellular matrix or bilayer matrix products&#44; and rotation or advancement flaps&#44; with or without the use of tissue expanders&#46; The surgeon in charge determined whether a conservative or surgical approach was indicated&#46; This decision was made based on lesion size&#44; bone involvement and the medical condition of the patient&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Whenever biological samples were obtained&#44; they were sent for histopathological examination&#44; and whenever a patient died&#44; an autopsy was performed to determine the cause&#46; In cases in which biological samples were not obtained&#44; the diagnosis was made based on the clinical manifestations&#46; Patients were followed up in the outpatient clinics to monitor the surgical wound or skin lesion and assess for comorbidities&#44; postoperatory complications and cosmetic outcomes&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0035" class="elsevierStylePara elsevierViewall">We reviewed the records of 23 patients that received an initial diagnosis of ACC&#44; and excluded one case in which the histological examination of the surgical specimen was not compatible with ACC &#40;nevus sebaceous of Jadassohn&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Twenty-two patients with ACC received treatment &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; In 54&#46;5&#37; &#40;12&#47;22&#41; of the patients&#44; diagnosis was made at birth with immediate initiation of treatment&#46; The rest of the patients &#40;10&#47;22&#41; received the diagnosis at birth&#44; but were referred for treatment at ages ranging from 4 months to 13 years&#44; with a median age of 32 months &#40;IQR&#44; 12&#8211;111 months&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">All scalp lesions were solitary&#44; except in one patient that had two adjacent lesions at the vertex level&#46; The diameter of the lesions ranged from 1<span class="elsevierStyleHsp" style=""></span>cm &#40;area&#44; 0&#46;79<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>&#41; to 14<span class="elsevierStyleHsp" style=""></span>cm &#40;area&#44; 153&#46;94<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>&#41;&#44; with a median diameter of 3&#46;5<span class="elsevierStyleHsp" style=""></span>cm &#40;IQR&#44; 2&#8211;7<span class="elsevierStyleHsp" style=""></span>cm&#41; to an area of 9&#46;81<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span> &#40;IQR&#44; 3&#46;14&#8211;38&#46;48<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>&#41;&#46; The lesions in the extremities consisted of lesions 2<span class="elsevierStyleHsp" style=""></span>cm in diameter &#40;area&#44; 3&#46;14<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>&#41; in the third finger of the right hand&#44; 3<span class="elsevierStyleHsp" style=""></span>cm in diameter &#40;area&#44; 7&#46;07<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>&#41; in both hands&#44; and 2<span class="elsevierStyleHsp" style=""></span>cm in diameter on the back of both hands and both legs&#46; The lesions in the patient with systemic involvement were large&#44; and affected approximately 20&#37; of the total body surface area&#44; especially the torso and the upper limbs&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Five patients with ACC in the scalp had associated diseases that included&#58; heart disease with ventricular septal defect&#44; duplex collecting system&#44; complete cleft palate with Pierre-Robin sequence&#44; Adams-Oliver syndrome&#44; and one girl with multiple malformations&#46; The other patients had dystrophic epidermolysis bullosa&#44; Streeter dysplasia and Bart syndrome&#46; Genetic testing was performed in only two patients&#44; and did not detect chromosomal abnormalities in either&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Scalp lesions were managed with conservative treatment in seven patients &#40;36&#46;3&#37;&#41;&#44; all of whom had lesions smaller than 4<span class="elsevierStyleHsp" style=""></span>cm &#40;12&#46;57<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>&#41;&#44; except for one lesion with a 9<span class="elsevierStyleHsp" style=""></span>cm diameter &#40;area&#44; 63&#46;62<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>&#41; that was managed conservatively due to high anaesthetic and surgical risk&#46; The rest of the patients were treated with surgery &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; The patient with a lesion of 14<span class="elsevierStyleHsp" style=""></span>cm &#40;154<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>&#41;&#44; with an associated bony defect of similar size underwent implantation of a biosynthetic matrix &#40;INTEGRA<span class="elsevierStyleSup">&#174;</span> Matrix Wound Dressing&#44; Integra LifeSciences Corporation&#44; Plainsboro&#44; New Jersey&#44; USA&#41; followed by a split-thickness graft to cover the defect&#46; The second patient with a large bony defect underwent primary closure of the scalp with no additional treatment on the bone&#44; and responded favourably&#46; The other two patients that had bony defects were managed conservatively&#44; and showed good bone development and closure of the defect&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Of the four patients that had lesions in the extremities&#44; two underwent surgery&#46; In one&#44; several full-thickness grafts were inserted in the lesions of the hands&#44; and a series of plastic surgeries were performed on the patient that had the lesion in the finger&#46; A biopsy was performed on the patient that had lesions on the hands and feet&#44; confirming the ACC diagnosis&#59; conservative management was chosen for this patient&#46; The patient with torso involvement received conservative treatment&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The median length of stay was less than 1 day &#40;IQR&#44; 0&#46;5&#8211;7&#41;&#44; with a maximum of 25 days&#59; patients were followed up for a median of 2 years and 7 months&#46; Two patients died in our study &#40;9&#46;52&#37;&#41;&#59; the first was a newborn girl aged 11 days with a polymalformative syndrome with complex heart disease that developed heart failure and a low-output intestinal fistula&#59; the second was a patient with Bart syndrome that died from haemodynamic decompensation resulting from the large size of the epidermolysis bullosa lesions&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">Aplasia cutis congenita is a rare disease characterised by the localised absence of skin&#44; and its incidence rate is of 1&#8211;3 per 10<span class="elsevierStyleHsp" style=""></span>000 live births per year&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">3&#44;4</span></a> Its specific causes are not known&#44; although it is assumed that the lesion develops <span class="elsevierStyleItalic">in utero</span> due to abnormal ectodermal development in the embryonic period secondary to a mechanical&#44; vascular&#44; teratogenic or hereditary disturbance&#44; unrelated to the delivery or first hours post birth&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">5</span></a> It has been described in association with isolated malformations such as patent ductus arteriosus&#44; tracheoesophageal fistula&#44; epidermolysis bullosa&#44; limb malformations&#44; cleft lip and palate&#44; and kidney malformations&#44; among others&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">6&#44;7</span></a> In our series&#44; 22&#37; of the patients had associated congenital malformations&#44; including one case of Adams-Oliver&#44; one of Streeter dysplasia and one of Bart syndrome&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Ultrasound examination in the last weeks of gestation may lead to prenatal suspicion of ACC&#44;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">8</span></a> although the condition is diagnosed by examination of the newborn&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">9</span></a> In our series&#44; 47&#46;5&#37; of the patients were referred to our clinic more than four months post birth&#44; even though the initial diagnosis had been made in the neonatal period&#46; We believe that an evaluation should be performed and an individualised treatment plan developed immediately after diagnosis&#46; If the diagnosis is uncertain&#44; a biopsy of the lesion could be performed to rule out other dermatoses&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">10</span></a> Additional testing is recommended to rule out associated anomalies&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">6</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Mortality due to haemorrhage&#44; sagittal sinus thrombosis or central nervous system infection can reach up to 50&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">2&#44;10&#44;11</span></a> Mortality is associated with larger lesion sizes and underlying bony defects&#46; Therefore&#44; treatment must be geared towards the prevention of these complications&#46; In our experience&#44; mortality was not associated with ACC complications&#44; but to complications of associated pathologies&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The typical presentation consists of a solitary lesion localised to the scalp vertex&#44; oval in shape&#44; well demarcated&#44; hairless&#44; with the longest diameter ranging between 1 and 3<span class="elsevierStyleHsp" style=""></span>cm &#40;area&#44; 0&#46;79&#8211;7&#46;07<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>&#41;&#44; and the appearance of scar or granulation tissue&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">10&#44;12</span></a> Seventy to ninety percent of cases involve the scalp&#44; and up to thirty percent are associated with bony defects&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">13</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">There is great controversy surrounding the treatment of ACC&#44; and there is no consensus as to the treatment approach or type of intervention that should be implemented&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">2</span></a> In our experience&#44; there are limited possibilities for adequate closure of the scalp due to its low elasticity&#44; restricted mobility&#44; spherical shape requiring longer skin flaps and limited tissue availability due to the need for preserving axial blood flow&#46; Therefore&#44; the therapeutic approach must be based on the size of the lesion and the presence or absence of underlying cranial defects&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">9&#44;14</span></a> Tissue specimens obtained during surgery should be submitted for histopathological examination to rule out other dermatoses&#44; including nevus sebaceous&#44; traumatic scarring&#44; scarring alopecia&#44; epidermolysis bullosa&#44; localised infection&#44; congenital dermoid cysts&#44; cutaneous meningioma and heterotopic brain tissue&#44; among others&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">10</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Lesions with a diameter of less than 2<span class="elsevierStyleHsp" style=""></span>cm &#40;area&#44; 3&#46;14<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>&#41; and no osseous involvement can be treated conservatively&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">2&#44;15</span></a> The cosmetic outcomes are good&#44; the risk of complications is low&#44; and anaesthesia is not required&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">16</span></a> Another possibility is to perform a radical excision of the lesion under local anaesthesia and sedation&#44; followed by primary closure&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Defects between 2 and 4<span class="elsevierStyleHsp" style=""></span>cm in diameter &#40;area&#44; 3&#46;14&#8211;12&#46;57<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>&#41; can be managed conservatively&#44;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">17</span></a> although primary closure of the defect is preferred if the defect is larger than 2<span class="elsevierStyleHsp" style=""></span>cm and with exposed bone&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">In cases involving lesions larger than 4<span class="elsevierStyleHsp" style=""></span>cm or bony defects&#44; the conservative approach is not recommended due to the risk of complications&#44; poor cosmetic outcomes and the need for longer hospitalisations&#46; Among the surgical options that have been described in the literature&#44;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">11</span></a> the one we performed most often was primary closure in a single or a series of surgeries&#46; Treatment with skin grafts&#44; dermal substitutes and skin flaps yielded good results and has been described extensively in other published case series&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">2&#44;6&#44;14</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Surgical treatment is preferred in cases associated with bony defects&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">11</span></a> The use of skin flaps has been described in the literature&#44; and this technique has shown very good outcomes and an associated decrease in the risk of complications&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">5&#44;6&#44;14</span></a> Other options include full-thickness grafts&#44; split-thickness grafts and tissue expansion&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">18</span></a> There have also been reports of the use&#44; with favourable outcomes&#44; of allografts&#44;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">19</span></a> acellular dermal grafts and cultured keratinocyte grafts&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">20</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Lesions in the torso or extremities may be managed conservatively&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">21</span></a> If the lesion is very large or it involves a joint&#44; surgical treatment with skin grafts or plastic surgery is recommended to avoid functional limitations or very large scars&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Complications following conservative or surgical treatment may include hypertrophic scarring and keloids with or without cicatricial alopecia and secondary infection of the wound&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">2&#44;10</span></a> In our case series&#44; the most frequent complication was scarring&#44; and it usually did not require additional surgeries&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">A broad range of therapeutic approaches are still being used for ACC&#46; Due to the characteristics of this study&#44; we were unable to determine which treatment is best for ACC&#44; but surgical management is usually preferred&#44; especially for larger lesions&#44; as it can prevent fatal complications and the cosmetic results are good&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusions</span><p id="par0130" class="elsevierStylePara elsevierViewall">We believe that ACC is a disease that carries the risk of potentially fatal complications&#44; but that these can be prevented with appropriate treatment&#46; While conservative management is an option&#44; we favour surgery as long as it can be performed on the patient&#46; Surgery&#44; regardless of which technique is used&#44; must be performed with the goal of closing the skin defect&#44; and should be considered especially for lesions more than 4<span class="elsevierStyleHsp" style=""></span>cm in diameter or with associated bony defects&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflicts of interest</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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            5 => "Adams-Oliver&#39;s syndrome"
          ]
        ]
      ]
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          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec601466"
          "palabras" => array:6 [
            0 => "Aplasia cutis cong&#233;nita"
            1 => "V&#233;rtex"
            2 => "Colgajos cut&#225;neos"
            3 => "Injertos cut&#225;neos"
            4 => "S&#237;ndrome de Bart"
            5 => "S&#237;ndrome de Adams-Oliver"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Aplasia cutis congenita &#40;ACC&#41; is a rare congenital malformation that commonly involves the scalp&#44; but can affect pericranium&#44; bone and dura mater&#46; Complications are rare&#44; but can be fatal&#44; so early treatment must be achieved&#46; The treatment remains controversial with no consensus between the conservative and surgical approach&#46; The aim of this study is to describe our experience in the management of ACC&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Retrospective review of the medical records of all children up to 14 years diagnosed with ACC and treated between 2000 and 2013&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">There were a total of 22 cases of ACC with lesions ranging from 1<span class="elsevierStyleHsp" style=""></span>cm &#40;0&#46;79<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>&#41; to 14<span class="elsevierStyleHsp" style=""></span>cm &#40;153&#46;94<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>&#41;&#46; ACC of the scalp was found in 18 cases&#44; with 3 in extremities and 1 in trunk&#46; Conservative treatment was performed on 9 patients and 13 underwent surgical treatment &#40;8 primary closures&#44; 2 plasties&#44; 2 skin grafts&#44; and 1 skin flap&#41;&#46; Two patients died due to complications of other diseases not related with the ACC&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">ACC is a rare disease that can be fatal&#46; A complete initial assessment to establish early treatment is necessary to prevent this&#46; Surgery should be considered as an initial therapeutic option in defects &#62;4<span class="elsevierStyleHsp" style=""></span>cm &#40;&#62;12&#46;6<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>&#41; as it prevents the risk of fatal complications&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Materials and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La aplasia cutis cong&#233;nita &#40;ACC&#41; es una malformaci&#243;n cong&#233;nita rara que afecta sobre todo al cuero cabelludo&#44; aunque puede afectar al pericr&#225;neo&#44; el cr&#225;neo y la meninges&#46; Las complicaciones pueden llegar a ser fatales&#44; por lo que es necesario un tratamiento oportuno&#46; El tratamiento sigue siendo controvertido&#44; sin encontrar un consenso entre el abordaje conservador y el quir&#250;rgico&#46; El <span class="elsevierStyleItalic">objetivo</span> de este estudio es describir nuestra experiencia en el manejo de la ACC&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio descriptivo retrospectivo de las historias cl&#237;nicas de los pacientes menores de 14 a&#241;os con diagn&#243;stico de ACC&#44; atendidos entre el a&#241;o 2000 y el 2013&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Veintid&#243;s casos de ACC con lesiones que variaban de 1<span class="elsevierStyleHsp" style=""></span>cm &#40;0&#44;79<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>&#41; a 14<span class="elsevierStyleHsp" style=""></span>cm &#40;153&#44;94<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>&#41;&#46; Dieciocho casos presentaron lesiones en el cuero cabelludo&#44; 3 en extremidades y uno en tronco&#46; Se realiz&#243; tratamiento conservador en 9 y quir&#250;rgico en 13 &#40;8 cierres primarios&#44; 2 plastias&#44; 2 injertos cut&#225;neos y un colgajo&#41;&#46; Dos pacientes fallecieron por complicaciones de otras patolog&#237;as no asociadas a la ACC&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La ACC es infrecuente y puede tener un desenlace fatal&#46; Para prevenirla es necesaria una evaluaci&#243;n inicial completa para establecer un tratamiento oportuno&#46; La cirug&#237;a es una buena opci&#243;n terap&#233;utica&#44; sobre todo en defectos con di&#225;metro<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>cm &#40;12&#44;6<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>&#41;&#44; ya que disminuye el riesgo de complicaciones mortales&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introducci&#243;n"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Material y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as&#58; Betancourth-Alvarenga JE&#44; V&#225;zquez-Rueda F&#44; Vargas-Cruz V&#44; Paredes-Esteban RM&#44; Ayala-Montoro J&#46; Manejo quir&#250;rgico de la aplasia cutis cong&#233;nita&#46; An Pediatr &#40;Barc&#41;&#46; 2015&#59;83&#58;341&#8211;345&#46;</p>"
      ]
    ]
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      0 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">IQR&#44; interquartile range&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Conservative treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Surgical treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Sex&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;31&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;36&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;68&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;9&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;22&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;31&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">Age in months&#44; median &#40;IQR&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;0&#8211;78&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;0&#8211;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Localisation of lesion&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Scalp</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;31&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;50&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;81&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Vertex</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;18&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;31&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#40;50&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Parietal</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;9&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;9&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Occipital</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;9&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;13&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Temporal</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Frontal</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Extremities</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;9&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;13&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Torso</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">Bony defect&#44;</span><span class="elsevierStyleItalic"><span class="elsevierStyleBold">n</span></span><span class="elsevierStyleBold">&#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;9&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;9&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;18&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Complications&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Scar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;9&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;36&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;45&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Death<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;9&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;9&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">Length of stay in days&#44; median &#40;IQR&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;1&#8211;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#8211;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#8211;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">Reoperation&#44;</span><span class="elsevierStyleItalic"><span class="elsevierStyleBold">n</span></span><span class="elsevierStyleBold">&#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;31&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;36&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Death due to causes unrelated to ACC&#46;</p>"
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Comparison of surgical and conservative treatment of aplasia cutis congenita&#44; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>22&#41;&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#60;2<span class="elsevierStyleHsp" style=""></span>cm <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2&#8211;4<span class="elsevierStyleHsp" style=""></span>cm <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;22&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;40&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;31&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;27&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13 &#40;59&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;18&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;18&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;36&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Graft&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;9&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Skin flap&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Plastic surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;9&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;9&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Bony defect</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;9&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;18&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Complications</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Scar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;18&#8211;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;45&#8211;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#8211;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#8211;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Death<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;9&#8211;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;9&#8211;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Reoperation</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;13&#8211;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;22&#8211;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;36&#8211;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Good cosmetic outcome &#40;n</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">20&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;15&#8211;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;30&#8211;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;15&#8211;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;60&#8211;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="char" valign="top"><span class="elsevierStyleItalic">Length of stay</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60;1 day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;22&#8211;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;9&#8211;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;31&#8211;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>1&#8211;5 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;9&#8211;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;18&#8211;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;9&#8211;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;36&#8211;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62;5 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#8211;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;13&#8211;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;13&#8211;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;31&#8211;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Death due to causes unrelated to ACC&#46;</p>"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Comparison by aplasia cutis congenita lesion size &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>22&#41;&#46;</p>"
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Aplasia cutis congenital and associated disorders&#58; an update"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Evers"
                            1 => "P&#46; Steijlen"
                            2 => "B&#46; Hamel"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Genet"
                        "fecha" => "1995"
                        "volumen" => "47"
                        "paginaInicial" => "295"
                        "paginaFinal" => "301"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7554362"
                            "web" => "Medline"
                          ]
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              "identificador" => "bib0115"
              "etiqueta" => "2"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Aplasia cutis congenita&#58; review of 29 cases and proposal of a therapeutic strategy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Maillet-Declerck"
                            1 => "M&#46; Vinchon"
                            2 => "P&#46; Guerreschi"
                            3 => "L&#46; Pasquesoone"
                            4 => "P&#46; Dhellemmes"
                            5 => "V&#46; Duquennoy-Martinot"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1055/s-0032-1322539"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Pediatr Surg"
                        "fecha" => "2013"
                        "volumen" => "23"
                        "paginaInicial" => "89"
                        "paginaFinal" => "93"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22903250"
                            "web" => "Medline"
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                      ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Aplasia cutis congenita&#58; a rare cause of elevated &#945;-fetoprotein levels"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; Gerber"
                            1 => "M&#46; de Veciana"
                            2 => "C&#46;V&#46; Towers"
                            3 => "G&#46;R&#46; Devore"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Obstet Gynecol"
                        "fecha" => "1995"
                        "volumen" => "172"
                        "paginaInicial" => "1040"
                        "paginaFinal" => "1041"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7534447"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
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                ]
              ]
            ]
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              "identificador" => "bib0125"
              "etiqueta" => "4"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Aplasia cutis congenita in a newborn&#58; etiopathogenic review and diagnostic approach"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Moros Pena"
                            1 => "M&#46; Labay Matias"
                            2 => "F&#46; Valle Sanchez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "An Esp Pediatr"
                        "fecha" => "2000"
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                        "paginaInicial" => "453"
                        "paginaFinal" => "456"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11003947"
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            4 => array:3 [
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Aplasia cutis cerebri with partial acrania &#8212;total reconstruction in a severe case and review of the literature"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46; Bajpai"
                            1 => "K&#46; Pal"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1053/jpsu.2003.50000"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr Surg"
                        "fecha" => "2003"
                        "volumen" => "38"
                        "paginaInicial" => "1"
                        "paginaFinal" => "4"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12592609"
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                    0 => array:2 [
                      "titulo" => "Aplasia cutis cong&#233;nita&#46; A case of scalp defect repair using two opposing bipedicled local flaps"
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                          "etal" => false
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