Ischemic Risk in Collodion Baby

Case Reports in Orthopaedics
15 Jan, 2021 ,

Pauline Besonhe presented a case of a newborn in which surgery was necessary to free both fingers and toes from constrictive bands responsible for ischemia. In the absence of surgery, the constrictive bands can lead to amputation (pseudoainhum). The purpose of this case report is to expose the management and the role of an orthopaedic surgeon in the treatment of a collodion baby.

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It is a case of a girl born from nonconsanguineous parents, of Algerian origin. The Apgar score was 9/10/10 at 1 minute, 5 minutes, and 10 minutes.

She had several signs of baby collodion: bilateral ectropion, eclabium, stenosis of ear canals, and nasal vestibules. The whole body was covered with collodion membranes. She was the first child of the family, and there was a familial antecedent in a first-degree cousin of the baby who had the same presentation at birth.

The orthopaedic surgeon was called to give his opinion about the hypoperfusion of the fingers and of the toes. Clinical examination revealed that the hands and feet were covered with a flexible membrane without constrictive bands at that time. The hypoperfusion of the extremities was relieved by Vaseline massages.

The newborn was admitted to the neonatology department and received specific care by a multidisciplinary team: dermatologist, ophthalmologist, neonatologist, ENT specialist, physiotherapist, and orthopaedist. The evolution was good; the little girl was able to close her mouth and eyes on day 7. The high humidity incubator was stopped on day 10. Unfortunately, on day 11, constrictive bands appeared at the root of the fingers and of the toes causing ischemia. We decided to surgically remove this ischemia. Under general anaesthesia, the membrane was opened like a book and completely removed. All fingers and toes were released from the membrane. The underlying skin appeared intact. No other complications were subsequently observed.

After the 4-month follow-up, the child was fine. She presented only remnant thin membranes at the back, the scalp, the axillary hollows, and the inguinal folds. The rest of the skin looked healthy. This case corresponds therefore to a “bathing suit ichthyosis.” Genetic analyses revealed 2 mutations in the TGM1 gene. As mentioned earlier, this gene is involved in autosomal recessive congenital ichthyosis, especially in the “bathing suit ichthyosis form.”