11.12 Pyogenic Granuloma (Proud Flesh)
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agk's Library of Common Simple Emergencies

Presentation
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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:
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- 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:
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- 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
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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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 from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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 1.202.237.0971 fax 1.202.244.8393 electra@clark.net
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