Subcutaneous pressure in cellulitis of the leg: can it be a predictor for early surgical intervention?

Background:Cellulitis, an infection of skin and subcutaneous tissue is usually managed conservatively and surgical intervention is required for local complications. The aim of this study was to correlate the subcutaneous pressure with the need for early surgical intervention in cases of lower limb cellulitis.Methods: We prospectively measured subcutaneous pressures in the normal leg and in the leg with cellulitis. Patients managed with parenteral antibiotics were compared to those managed with parenteral antibiotics and surgical intervention with standard statistical tests.Results:The median subcutaneous pressure was 3 mmHg and 9 mmHg in the normal leg and the other with cellulitis respectively. The mean of difference in subcutaneous pressure in legs with cellulitis compared to normal legs was 5.93 mmHg and 8.29 mmHg in the conservative group and surgical intervention group respectively. The difference in subcutaneous pressure between the normal leg and in the leg with cellulitis was statistically significant (p<0.001). The difference in the average pressure between surgical intervention group and conservative group was 2.36 mmHg and was statistically significant (p<0.05). The optimal threshold (difference in pressure) was identified as >=7 with sensitivity of 85.7% and specificity of 57.1%. Area under the ROC curve (SE) was 0.71 (0.10) with 95% CI (0.51, 0.87).Conclusions:The subcutaneous pressure in leg with cellulitis is a predictor for the need for early surgical intervention. It can be used as an adjunct in management and clinical decision making for cases of cellulitis of lower limbs.