Edited by Laura Lu and Matthew Lindsey - 7/1/2021
Descriptors
Cellulitis, Soft tissue infection
Exam Pearls
Examine for erythema, presence of abscess, draining wound
Important to assess timing of progression, hemodynamic stability, risk factors for MRSA
Examine erythema relative to drawn lines (or draw the lines yourself)
If digit, look out for Kanavel signs concerning for flexor tenosynovitis
Workup
Radiographs: Orthogonal XR of affected extremity, assess for foreign body, subcutaneous air
Other imaging: If equivocal exam for abscess, CT of extremity for abscess
Labs: CBC, ESR, CRP. LRINEC score if concern for NSTI.
Other: none
Management
Need for acute intervention: Only if there is a drainable abscess. Cellulitis without collection does not need surgical intervention.
Weight-bearing and range of motion: WBAT, ROMAT
Type of immobilization: May place a splint for soft tissue rest, aggressive elevation, possibly skyhook for hand
Admission or discharge status:
If hemodynamically stable and has not had trial of PO antibiotics, can discharge on PO abx with strict return precautions.
If hemodynamically unstable, rapid progression, or over indwelling device, should admit for IV antibiotics.
If no surgical intervention indicated (e.g. non-purulent cellulitis, not NSTI, no associated deep soft tissue collection etc.), admit to Medicine for IV antibiotics.
Anticoagulation: none
Antibiotics: Antibiotics without surgery is the mainstay of treatment. Need coverage for beta hemolytic strep and possibly MRSA if patient has risk factors
Surgical Indications
Absolute: rapid progression concerning for NSTI, hemodynamically unstable from purulent cellulitis
Relative: none
Not an indication: non-purulent cellulitis