# Conservative tissue sparing management of pediatric pyogenic granuloma with preserved joint function: A narrative review with an illustrative case

## TL;DR

This paper presents a case where a child's pyogenic granuloma near the fingers was successfully treated with conservative methods, preserving joint function.

## Contribution

The paper introduces a novel conservative treatment approach for pediatric pyogenic granuloma near joints, avoiding surgery while preserving mobility.

## Key findings

- Topical steroid-antibiotic therapy combined with staged debridement resolved pyogenic granuloma in a child.
- The treatment preserved full joint function and prevented flexion contraction.
- Histopathological confirmation was not performed, highlighting a limitation of the approach.

## Abstract

The pediatric population presents specific management challenges with pyogenic granuloma (PG), particularly when located near joints, as surgical treatment may compromise mobility. While surgical excision remains the gold standard treatment, emerging reports suggest that more conservative approaches may be suitable in select cases, offering less invasive treatment options. We report the preservation of joint function while successfully resolving pyogenic digital granuloma with topical steroid-antibiotic preparations. A healthy 7-year-old girl presented with progressive left middle and ring finger exacerbation of lesions attributable to sheep fence lacerations. Primary closure was performed; however, it resulted in recurrent serous collections, necessitating the use of a patch of granulation tissue. Examination revealed non-tender digit swelling at the volar aspect of the middle and distal phalanges with maintained flexor digitorum muscles, intact sensation, and no Kanavel signs. The child underwent staged bedside debridement under a digital block and removal of sutures lodged within the granulation tissue. Conservative treatment included daily steroid-infused dressings with fusidic acid ointment, overlapping two debridement sessions spaced 1 week apart. No lesions were noted post-treatment, along with a full range of movement and intact sensation. Skin loss traversing the flexor creases did not result in any form of flexion contraction and remained satisfactory at follow-up. This case demonstrates that dual-action corticosteroid-antibiotic therapy, combined with stepwise debridement, can achieve functional preservation of the joint in children with digital PG. In certain pediatric patients, where the lesions are located in functionally important regions, this surgical excision alternative is beneficial. It must be noted, however, that the lack of confirmation through histopathological analysis in this case represents a significant limitation that should be considered in the course of clinical reasoning.