Laser Photo-Destruction of Pyogenic Granulomas of the Skin in Children

Abstract

Introduction. Pyogenic granuloma (PG), a benign vascular tumor of the skin of inflammatory etiology, is often met in children. Complications of this pathology (ulceration and bleeding) are seen in 7.5% of cases. Material and methods. 67 patients were operated on for pyogenic granulomas. 22 patients had bleedings. Before surgery, all patients had sonography with color Doppler mapping of this vascular formation. 57 children had a planned surgery and were operated under topical anesthesia in the outpatient unit. 10 patients on admission had bleedings from pyogenic granulomas. After conservative arresting the bleeding, 7 patients out of these 10 had urgent surgery; in other three children with severe bleeding hemostasis was not achieved conservatively, and they were immediately operated on. All urgent surgical interventions were made under local anesthesia in an outpatient operating room. Patients with emergency cases, were younger than 3 y.o. They were operated in the operation room in the hospital under general anesthesia. Pyogenic granulomas in all 67 patients were removed by the technique of interstitial selective laser photodestruction, the prototype of which was “Method for treating cavernous forms of hemangiomas in children” developed and patented in CRIEPST. For this surgical intervention, two-wave laser surgical device “IRE-Polyus” (Russia), with wavelength of 0.97 mkm and 1.56 mkm was used. Results. Postoperative period in all patients was uneventful, with complete healing of wound defect in 10-12 days; no recurrences of vascular formation or its residual elements were observed in any case. All 67 patients had good clinical and aesthetic results after the applied surgical technique. Conclusion. To prevent complications in children with pyogenic granulomas, surgical treatment with the technique of interstitial selective laser photodestruction adapted for this pathology is recommended. The described interstitial selective laser photodestruction radically removes pathological tissues of pyogenic granulomas and ensures reliable hemostasis, what leads to good clinical and aesthetic results in treating the discussed group of patients both in inpatient and outpatient settings.