Julie Johnson

John R. Fowler


  • Pathoanatomy—It is infection of dermis and subcutaneous tissue without associated abscess.

  • Mechanism—Infection is through bacterial breach of cutaneous surface, however, a break in the skin is not required for spread of bacteria

  • Epidemiology in the United States is about 14.5 million cases annually with approximately 12% in the upper extremity, with a slight male predominance

  • Risk factors include trauma, IV drug use, immunocompromised patients, diabetes mellitus, steroid use, skin disorders (eczema, shingles), obesity


  • History reveals pain, fever, abrasion, puncture wound, or insect bite, expanding erythema

  • Physical examination shows erythematous, swollen, painful hand, which may have associated lymphangitis

  • Laboratory studies present elevated WBC, ESR, CRP, and lactate (lack specificity), <5% have a positive blood culture, skin biopsy yields a pathogen in 20% to 30% of cases—culture and biopsy are not recommended

  • Imaging—Radiographs will show soft tissue swelling without bony pathology

    • Should be ordered to rule out osteomyelitis and/or foreign body

  • Classification—Infection is classified as mild (no systemic signs), moderate (has systemic signs), severe (has systemic signs, purulence, and is rapidly evolving)

FIGURE 48.1 Cellulitis over dorsum of hand with erythema and swelling.

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May 7, 2019 | Posted by in ORTHOPEDIC | Comments Off on Cellulitis
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