11.12 Pyogenic Granuloma (Proud Flesh)

agk’s Library of Common Simple Emergencies

Presentation

Often there is a history of a laceration several days to a few weeks before presentation in the ED. The wound has not healed and now bleeds with every slight trauma. Objective findings usually include a crusted, sometimes purulent collection of friable granulation tissue arising from a moist, sometimes hemorrhagic wound. There are usually no signs of a deep tissue infection.

What to do:

• Cleanse the area with hydrogen peroxide and povidone-iodine solution.
• Cauterize the granulation tissue with a silver nitrate stick until it is completely discolored.
• Dress the wound after applying povidone-iodine ointment and have the patient repeat ointment and dressings 2-3 times per day until healed.
• Warn the patient about the potential signs of developing infection.

What not to do:

• Do not cauterize any lesion that by history and appearance might be neoplastic in nature. These lesions should be referred for complete excision and pathologic examination.
• Do not cauterize a large or extensive lesion. These should also be completely excised.

Discussion

It is not uncommon for a secondary cellulitis to develop after cauterizing the granuloma. It is therefore reasonable to place a patient on a short course (3-4 days) of a high dose antibiotic (dicloxicillin or cephalexin 500mg tid or cefadroxil lgm qd) when the wound is located on a distal extremity.

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