Search

Introduction. Pyogenic granuloma (PG) is a vascular inflammatory hyperplasia involving the skin and oral mucosa, often associated with local irritation or trauma, or with pregnancy. Intraoral location usually affects the gingiva, but tumoral aspect can be misleading, especially in extra-gingival locations. A thorough assessment and diagnosis are therefore important for ensuring the proper treatment. Case presentation. We report the case of a 12-year-old boy who presented for a growing and bleeding tumour of his lower lip mucosa. The tumour was labeled as “hemangioma”. It was growing for several weeks and associated with minor, but repeated mucosal trauma. Although the anatomic location was not common, the patient history suggested a diagnosis of PG. After a dermatologic assessment, which proposed a differential diagnosis with oral papilloma, a soft tissue ultrasound sustained the clinical diagnosis. The tumour was surgically excised and the defect was closed directly with absorbable sutures. Three weeks later the mucosa had a healthy appearance, without signs of impaired healing or tumour recurrence. The histopathological exam confirmed the clinical diagnosis. Conclusions. There are several types of soft tissue solid or vascular tumours that can be mislabeled and the diagnosis of hemangioma is commonly used for various vascular anomalies. In our case, the clinical aspect, together with the tumoral growing pattern and the history of repeated trauma, led us to the correct diagnosis and treatment. Surgical excision completely removes the PG and ensures rapid and esthetically convenient healing, without complication or tumour regrowth. more...

Introduction. Skin and soft tissue defects in lower extremity are challenging clinical situations that have to be dealt with on an individual basis. Closure technique must be tailored to the wound size, location and etiology, and also to the patient’s characteristics (age, other comorbidities etc.). This paper aims at emphasizing the clinical particularities of lower extremity wound closure in children. Material and methods. We review the clinical data, surgical strategy and operative staging, and also the postoperative outcome of three cases of children (aged between 4 and 9 years old) with skin and soft tissue defect cause by trauma and infection, operated in our department in 2017. Results. The three patients presented with lower leg and anterior foot skin and soft tissue defects, ranging from 5 to 10 cm on the long axis, with deep involvement (including joint exposure in one of them). Etiology was traumatic in two cases, one complicated by infection due to inappropriate initial cure. In the third case, the skin defect was caused by foot cellulitis that was incised and debrided in another hospital, and was referred to us for closure of the remaining uncovered wound. The surgical approach was to use local flaps and skin grafts, alone or combined, after thorough debridement and removal of all infected and devitalized tissue, combined with systemic antibiotics. Postoperative assessment at 1-2 months showed very good graft take and convenient scar appearance, with no functional impairments and no other complications. Conclusions. Surgical protocol for closing lower extremity skin and soft tissue defects raises technical problems, even in the young patient. However, a careful planning of closure steps and preparation of good quality underlying tissues may ensure fast and satisfactory results for the patient and his/her family, as well as for the treating physician. more...