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, Some times 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.
