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DERMATO SURGERY
Year : 2000  |  Volume : 66  |  Issue : 1  |  Page : 29-31

Crushing assisted shave excision and electrodesiccation: A novel approach to treat granuloma pyogenicum




Correspondence Address:
Subrata Malakar


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Source of Support: None, Conflict of Interest: None


PMID: 20877016

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  Abstract 

Background: Granuloma pyogenicum (GP) is a common vascular lesion which often bleeds easily during most of the treatment modalities. A number of pyogenic granulomas often recur after such treatment. Objective: The aim of this study was to establish a surgical procedure which is easy to operate, less invasive, minimal bleeding at the operation site and without any recurrence of the lesion. Methods: Twenty-three patients (15males, and 8females) suffering from granuloma pyogenicum at different stages (ulcerated, reepithelialized and resolving) and at various sites of the body constituted the sample population. In all the patients, crushing of the base of the lesions followed by shave excision and electrodesiccation of the shaved base were carried out. The patients were followed up for six months to observe recurrence, scar formation and any other complications. Results: Bleeding was practically nil during the surgical procedure in all the cases. There was no recurrence and cosmetic outcome was excellent. No complications were encountered. Conclusion: The technique is not only an alternative modality but can also be the treatment of choice in all stages of granuloma pyogenicum


Keywords: Granuloma pyogenicum, Crushing assisted shave excision, Electrodesiccation


How to cite this article:
Malakar S, Malakar RS. Crushing assisted shave excision and electrodesiccation: A novel approach to treat granuloma pyogenicum. Indian J Dermatol Venereol Leprol 2000;66:29-31

How to cite this URL:
Malakar S, Malakar RS. Crushing assisted shave excision and electrodesiccation: A novel approach to treat granuloma pyogenicum. Indian J Dermatol Venereol Leprol [serial online] 2000 [cited 2019 Sep 15];66:29-31. Available from: http://www.ijdvl.com/text.asp?2000/66/1/29/4857



  Introduction Top


Granuloma pyogenicum refers to a rapidly growing, often ulcerated papule or nodule [1] that usually appears shortly after a minor injury or infection of the skin.[2] Although the pathogenesis of pyogenic granuloma is not understood precisely, the condition does not develop unless the dermis has been injured by an external insult. [1] The dermatosis most often affects children or young adults of either gender, but the age range is wide. [2] It occurs espe­cially on exposed surfaces such as the hands, fingers, and face, particularly the lips and gums. [3],[4]

The condition may persist indefinitely unless destroyed. [2] The treatment modalities available are electrodesiccation with curettage, carbon dioxide laser surgery, cryosurgery with liquid nitrogen, chemical cauterization [5] and excision.[6] Recurrence after surgery or cautery is not rare.[2]

The technique described herein ensures total destruction of the lesion, no intraoperatve bleeding, and there was not a single recurrence.


  Patients and Methods Top


Twenty-three patients constituted the sample population. Fifteen were males and eight females. The age ranged between 10 years and 58 year (mean 27.5.years).

Twelve (52.16%) had ulcerated lesions, eight (34.78%) reepithelialized [Figure - 1] and rest three (1.30%) resolving pyogenic granuloma [Table - 1]. Nose was affected in 7(3.43%) patients, scalp in 3(1.30%), lips in 5(21.73%), fingers in 4(17.39%), and the rest 4(17.39%) had GP on cheeks and chin [Table - 2]

All the lesions were treated following these four steps (CECE): a) after local anaesthesia with 2% xylocaine with adrenaline, the base of the lesion was crushed by mosquito forceps [Figure - 2],b the lesion was then removed by shave excision [Figure - 3] using no. 10/11 scalpel blade, c the mosquito forceps was removed [Figure - 4] after 1 to 2 minutes of shave excision to ensure adequate crushing of the vessels at the base, d) electrodesiccation [Figure - 5]& [Figure - 6] of the base.

No dressing was required except topical antibiotic ointment to cover the operated site. The ointment was continued twice daily till formation of crusting which usually fell down by 6th to 10th post­operative day. A short course of systemic antibiotic was prescribed in all the patients.


  Results Top


All the patients were treated following the above four steps (CECE). Excellent cosmetic results were obtained in all of them. Hardly any imperceptible scar was noticed and there was not a single recurrence in six months follow-up period. No other complication (s) was observed.


  Discussion Top


A number of modalities are available for treating granuloma pyogenicum. Of these, curettage and electrodesiccation is the therapy of choice.[5] But it suffers from the drawback of intraoperative bleeding which leads to poor visualization of the operative field. Rapid, haphazarded and improper electrodesiccation may cause either overdoing it resulting in scar or underdoing it causing recurrence. Carbon dioxide laser surgery is the story of recent years and has been tried successfully. However, re­currence of GP and scarring following laser surgery may occur and dyschromias remain the possibilities in type IV and type V skin. Moreover it is costlier than the other procedures. Cryosurgery is less effective than the above two modalities and dyschromias are common,especially in type IV and type V skin. Chemical cauterization (silver nitrate stick, mono-,di-,or trichloroacetic acids) may also be efficacious. But the depth of penetration of these chemicals cannot be predicted resulting in uncertainity of the outcome. In all probability, the chemicals lack penetration through the tumour mass deep into the dermis.

A number of granulomas recur after these therapies due to the fact that the proliferating vessels in the base extend in a conical manner into the deeper dermis.[6] In such instances repeat electrodesiccation, cryosurgery with liquid nitrogen, carbon dioxide laser surgery, or excision may yield good result but scar, especially after excision is a predictable outcome.

In CECE, i, e., crushing ensured shave excision and electrodesiccation, the mosquito forceps crushes not only the base of GP [Figure - 2] but also the pressure encircles quite a good distance away from it which ensures the full destruction of the proliferating vessels growing conically into the dermis. Furthermore, the crushing prevents intraoperative bleeding [Figure - 3] & [Figure - 4]. Destruction of all the proliferating vessels at and around the base prevents the recurrence.

The simple technique (CECE), which is easy to practice, takes a few minutes, cosmetically excellent and devoid of recurrence can be the procedure of choice for granuloma pyogenicum.

 
  References Top

1.Fitzpatric R TB, Eisen AZ, Wolff K, et al. Dermatology In General Medicine, ed 4. New York, McGraw- Hill, Inc,. 1993,1231-1233.  Back to cited text no. 1    
2.Calonje Wilson- Jones E. Vascular tumours: Tumours and tumour-like conditions of blood vessels and lymphatics In: Elder D, Lever's Histopathology of the skin; Lippincot- Raven, NewYork, 1997 ;895-897.  Back to cited text no. 2    
3.Mills SE, Cooper PH, Fechner RE. Lobular capillary hemangioma: the underlying lesion of pyogenic granuloma. A study of 73 cases from the oral and nasal mucous membranes. Am 3 Surg Pathol 1980;4:471.  Back to cited text no. 3    
4.Patrice SJ, Wiss K, Mulliken JB. Pyogenic granuloma (lobular capillary hemangioma):A clinicopathologic study of 178 cases. Pediatr Dermatol 1994;8:267.  Back to cited text no. 4    
5.Arndt KA. Manual of Dermatology, Therapeutics, ed 5. Boston, Little, Brown and Company. 1995;205.  Back to cited text no. 5    
6.Hurwitz S. Clinical Pediatric Dermatology, Philadelphia, W.B. Saunders Company. 1993; 257-258.  Back to cited text no. 6    


Figures

[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6], [Figure - 7], [Figure - 8], [Figure - 9], [Figure - 10]

Tables

[Table - 1], [Table - 2]



 

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