Trap technique for bloodless removal of digital pyogenic granuloma

Accepted Manuscript Trap technique for bloodless removal of digital pyogenic granuloma Deepak Jakhar, MD, Ishmeet Kaur, MD PII:

S0190-9622(19)30605-X

DOI:

https://doi.org/10.1016/j.jaad.2019.04.019

Reference:

YMJD 13363

To appear in:

Journal of the American Academy of Dermatology

Received Date: 29 March 2019 Accepted Date: 10 April 2019

Please cite this article as: Jakhar D, Kaur I, Trap technique for bloodless removal of digital pyogenic granuloma, Journal of the American Academy of Dermatology (2019), doi: https://doi.org/10.1016/ j.jaad.2019.04.019. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

ACCEPTED MANUSCRIPT

Title: Trap technique for bloodless removal of digital pyogenic granuloma

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Running Title: Trap technique for pyogenic granuloma

Authors: Deepak Jakhar, MD

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Ishmeet Kaur, MD

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Department of Dermatology

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Affiliation:

North Delhi Municipal Corporation Medical College & Hindu Rao Hospital New Delhi – 110007, India 2

Consultant Dermatologist

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Kaya Skin Clinic

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New Delhi, India

Address for correspondence:

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Dr. Deepak Jakhar

Department of Dermatology North Delhi Municipal Corporation Medical College & Hindu Rao Hospital New Delhi – 110007, India Ph no- +91-9654616205 E Mail id: [email protected] Category:

Surgical Pearl

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Word count:

164

Number of figures:

2

Number of References: 0 None

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Conflict of interest:

Financial disclosure: None

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Keywords: pyogenic granuloma; surgical removal; tourniquet, penrose drain, lobular capillary

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hemagioma

Trap technique for bloodless removal of digital pyogenic granuloma

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Clinical challenge

Pyogenic granuloma (PG) is a lobular capillary hemagioma. Owing to the vascular nature, they have high tendency to bleed during surgical removal. PG at highly vascular sites like digits

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further complicates the issue. A bloodless surgical field is required to assist in complete removal

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of PG to prevent recurrence. Solution

A Penrose drain is frequently used as a tourniquet to achieve hemostasis. The same tourniquet can be used during surgical removal of PG (Fig 1a). After giving digital block anesthesia, the tourniquet is wrapped from the distal end of the digit to ensure exsanguinations of blood (Fig 1b). Trapping the PG in between, the tourniquet is extended proximal to the PG (Fig 1c).

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Keeping both the ends of tourniquet in place secures a bloodless field for surgical removal of PG (Fig 1d). A bloodless surgical field provides a better opportunity for complete surgical removal

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of PG, thus decreasing chances for recurrence. Legends

Figure 1: Pyogenic granuloma (PG) over the right ring finger (a); penrose drain over the distal

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end of digit (b); trapping the PG and moving proximal (c); bloodless surgical removal of PG (d).

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