How do you get rid of a recurring Pyogenic Granuloma that has caused Osteomylitis and amputation of a big toe?

Question:

Skin grafts have been attempted as has numerous excisions. Osteomylitis of the bones in the great toe resulted in amputation of the toe.
Wound flap failed and wound has taken 4 months to heal, now is beginning to over granulate again.
No history of diabetes or any other such.

Suggestions or advice appreciated

Answers:
Have you tried a polyurethane foam dressing?

Harris and Rolstad report the findings of a small clinical trial of a polyurethane foam to treat over granulation:
“Although there is very little in the literature regarding hypergranulation tissue, the fact that there are numerous treatments by various wound clinicians demonstrates the recognition of its presence as a clinical problem. The paucity of published information prompted the authors to design a study to collect objective data on a treatment method they had found useful in their practices. This article explores the issue of hypergranulation and offers a nontraumatic method of management. A prospective non-controlled correlational study was undertaken with ten patients and twelve wounds using a polyurethane foam dressing to reduce hypergranulation tissue. The results demonstrated a significant decrease in height of 2 mm of granulation tissue from initial measurements to measurements taken two weeks later."

Source(s):
Harris A and Rolstad BS. Hypergranulation tissue: a non-traumatic method of management. Ostomy Wound Manage. 1994 Jun;40(5):20-2, 24, 26-30. (http://www.hubmed.org/display.cgi?issn=08895899&uids=7546080).

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How do you get rid of a recurring Pyogenic Granuloma that has caused Osteomylitis and amputation of a big toe?

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