Outcome of Patients Undergoing Treatment for Cellulitis/Lymphangitis

Abstract

A lot of patients come to surgery outpatient department with persistentlymphedema following an attack of cellulitis/lymphangitis. Many of the patients undergo conservative management with antibiotics analgesics and supportive measures. Some patients undergo fasciotomy for the same. Objective of this observational study is to look for the incidence of persistent lymphedema in patients undergoing fasciotomy for cellulitis/lymphangitis and patients undergoing conservative management for the same.

This is an observational study of 86 patients admitted with cellulitis/lymhangitis , undergoing treatment( 40 patients underwent fasciotomy ,43 patients underwent conservative) in surgical wards of tertiary care center For the incidence of persistent lymphedema.

Among the 40 patients who underwent fasciotomy for cellulitis/lymphangitis, 7 patients (17.5%)developed persistent lymphedema at the end of 1 year and Among the 43 patients who underwent conservative management for cellulitis/lymphangitis,17 patients (39.5%) developed persistent lymphedema at the end of 1 year.

Incidence of persistent lymphedema following fasciotomy is less compared to conservative treatment. Hence fasciotomy is an effective procedure for severe cellulitis /lymphangitis.

Authors

Musafir khan1, Sivaprasad S2
1Senior Resident, Medical College, Thiruvananthapuram.
2Associate Professor, Medical College, Manjeri

Keywords:

cellulitis , lymphangitis, fasiotomy, persistent lymphedema

Introduction

Cellulitis is a relatively common infection of the skin and subcutaneous tissue associated with high morbidity and a burden on healthcare resources. Lymphoedema the accumulation of fluid in interstitial spaces can occur as a consequence of cellulitis. Similarly, the presence of chronic
lymphoedema can predispose to recurrent episodes of cellulitis.

Various risk factors have been shown to be associated with cellulitis, with lymphoedema showing the strongest association (Dupuy et al, 1999). This is particularly the case in recurrent cellulitis. Streptococcal cellulitis associated with lymphoedema can be aggressive with severe symptoms and
morbidity (Bonnetblanc and Bedane, 2003)

Lymphangitis is defined as an inflammation of the lymphatic channels that occurs as a result of infection at a site distal to the channel.

A lot of patients come to our outpatient department with persistent lymphedema following an attack of cellulitis/lymphangitis. Many of the patients undergo conservative management with antibiotics analgesics and supportive measures. Some patients undergo fasciotomy for the same. No elaborative studies have been done previously to identify the reason and incidence of persistent lymphedema following an attack of cellulitis/lymphangitis.

Objective of this observational study “outcome of patients undergoing management for observational study “is to look for the incidence of persistent lymphedema in patients undergoing fasciotomy for cellulitis/lymphangitis and patients undergoing conservative management for the same. Here patients are followed up for about 1 year to look for persistent lymphedema.

Methodology

This is a study to look for the incidence of lymphedema in patients undergoing fasciotomy for cellulitis/lymphangitis and patients undergoing conservative management for the same. Here patients are followed up for about 1year to look for persistent lymphedema.

Study Subjects were patients undergoing fasciotomy for cellulitis/lymphangitis and Patients undergoing conservative management for cellulitis/lymphangitis.

Patients with renal failure, hypoalbuminemia, congestive heart-failure, protein-losing nephropathy, pulmonary hypertension, obesity, pregnancy, and drug-induced edema were excluded.

A semistructured questionnaire was developed to record the medical history and examination details. Patients fulfilling the inclusion criteria were enrolled into the study and evaluation and recording after getting a written informed consent.

Assessment of the lower extremities begins with a visual inspection of the legs.Color, presence of hair, visible veins, size of the legs, ulcerations,lack of hair should be noted. If swelling is observed, the calf circumference should be measured with a tape measure. This measurement can be compared to future measurements to see if the swelling is getting better. Determine if elevating the legs makes the swelling go away. Pressure should be applied with the fingertips over the ankle to determine the degree of swelling. The assessment should also include a check of the popliteal, femoral, posterior tibial, and dorsalis pedis pulses. When checking the femoral pulse, feel for the inguinal nodes and determine if they are enlarged. Data collected using proforma and details were entered into Microsoft excel and analysed with statistical package for social sciences software programme(SPSS ver 18.)

Results

Out of 83 patients in this study 43 patients undergo conservative management for cellulitis/lymphangitis and 40 patients undergo fasciotomy for the same.

Among the 40 patients who underwent fasciotomy for cellulitis/lymphangitis, 7 patients(17.5%) developed persistent lymphedema at the end of 1year and among the 43 patients who underwent conservative management for cellulitis/ lymphangitis, 17 patients (39.5%)developed persistent lymphedema at the end of 1 year.

Blue –undergoing fasciotomy , Green – conservative treatment
1.nopersistent lymphedema 2.persistent lymphedema

Conclusion

Surgical outcomes are good following double incision fasciotomy for severe cellulitis and lymphangitis and Complications following fasciotomy are relatively benign and are less common. Incidence of persistent lymphedema following fasciotomy is less compared to conservative treatment. Hence fasciotomy is an effective procedure for cellulitis going into compartment syndrome.

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Acknowledgements: None.
Conflict of Interest: None
Address for Correspondence:
Dr. Musafir khan
Senior Resident, Medical College, Thiruvananthapuram