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pyrogenic granuloma

Discussion in 'Foot Surgery' started by Claudina, Dec 26, 2008.

  1. Claudina

    Claudina Member


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    First of all regards! and hope you all have had a wonderfull christmas. I would like some information on the proper surgical procedure which is best used for removing a pyrogenic granuloma on the lateral border of the hallux
    Regards
    Claudina
     
  2. Lee

    Lee Active Member

    It depends how far the flames shoot out of it. :santa2:
     
  3. Claudina

    Claudina Member

    lets put it that way it is inflammed and there is pus production a previous pna with phenolisation has already been performed, as igtn was suspected, i found the frost procedure, but i dont know if it is correct or if there are other procedures which can be better.
     
  4. Dr. DSW

    Dr. DSW Active Member

    If there is granuloma formation, I would anesthetize the toe and first suspect that there is still some nail spicule that is still present. Often following a partial nail avulsion, I have seen that a small piece of nail or nail spicule may break off or be missed and left in the nail border. Most often, this presents at the extreme tip of the nail groove and has often been broken off prior to the patient entering your office. It is often a small spicule that almost is growing out the distal nail groove and out the end of the toe.

    The patient attempts to cut the nail and leaves the small spicule behind. By the time the patient enters the office, the entire nail groove is inflamed, and when the nail border is avulsed or a P & A is performed, this small spicule is often left behind.

    Therefore, I would excise/curette the granuloma (expect bleeding) and use a small curette to carefully explore the ENTIRE nail groove, especially the extreme distal groove for a small spicule. After the granuloma has been curetted and/or sharply excised, it can often be chemically cauterized with silver nitrate applicator sticks or electrically cauterized.

    It is rarely necessary to perform a Frost type procedure for a granuloma. Please remember that a granuloma USUALLY occurs as a result as a reaction to some irritant. That's why I'd explore the area carefully.

    Hope this helps.
     
  5. HJM41

    HJM41 Member

    After a P&a possible that you just not have allowed it to drain however always take an x-ray to rull out osteo i would start with a culture open and allow to drain then do the procedure that you are best at frost winograd zadik
     
  6. W J Liggins

    W J Liggins Well-Known Member

    Hi Claudia

    I think Lee's message was a merry Christmas joke over a typo. 'pyrogenic' for pyogenic.

    It is possible that the granuloma is caused by an inclusion cyst. Unusual after phenolisation but it is possible that matrical cells are still producing some nail under the eponychium. Having gone through the good advice already given - and a C & S should return a positive result if the problem is infective, I would go along with the Frost or Winograd procedure.

    All the best

    Bill Liggins
     
  7. Claudina

    Claudina Member

    thanks very much you were very helpful with all the info you gave me
    Cant thank you enough
    Regards
    Claudine
     
  8. Anne Marie

    Anne Marie Welcome New Poster

    if the pyogenic granuloma re occurs after it is curetted and chemically cauterized, would it be best to do a frost procedure or a winograd ? the lesion is on the fibular border of the hallux

    thank you

    anne marie ( 3rd year BSc(Hons) podiatry student at the univeristy of malta)
     
  9. Dr. DSW

    Dr. DSW Active Member

    In my opinion, if any lesion recurs, in addition to considering the next procedure to perform it is imperative to also perform a biopsy. The results of the biopsy may dictate the next procedure to perform!
     
  10. Rob Elliott

    Rob Elliott Welcome New Poster

    Hi Claudina

    I found an article on pubmed that details a study that successfully removed pyogenic granulomas using cryosurgery. Enter pyogenic granuloma into the search facility at pubmed and you should be able to find it. A possible alternative to the suggestions in other posts.

    Cheers
    Rob
     
  11. drsarbes

    drsarbes Well-Known Member

    Hi Claudina:
    I feel motivated to add a post here since apparently you've been going back and forth.
    Re-read Dr DSW's first post (even though I hate agreeing with him! hahaha <------a joke)
    he's exactly right.
    These are not uncommon and almost always due to continued infection from a missed spicule.
    Find the offending nail, remove the granuloma and wrap it up good.
    Steve
     
  12. Dr. DSW

    Dr. DSW Active Member

    Now that Steve (Dr. Arbes) has agreed with me, we can definitely put this subject to rest!!!
     
  13. drsarbes

    drsarbes Well-Known Member

    Claudia:
    How did it go?

    Steve
     
  14. Gibby

    Gibby Active Member

    Dr. DSW is correct.
    Very common, most likely a nail spicule.
    Antibiotics after procedure, post-op shoe.
     
  15. David Smith

    David Smith Well-Known Member

    Claudia

    Regarding pyogenic granulomas, I'm not a surgeon but granulomas are very common presentation in everyday podiatry clinic and are simple to get rid of.

    After removing the nail spike I usually take the bulk off with a pair of tissue cutters and then trim with a scalpel if necessary. I then pack with Seasorb and tightly dress, as also indicated by DrSarbes, with instructions to leave dressed for 5 days. I tend to avoid silver nitrate at first since people don't like a big black mark left on their toe and plus it stings like mad. I find this very successful but sometimes Silver nitrate is required.

    Cheers Dave
     
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