Gopalakrishnan Shriswaruthi, Kr Sairam, Christina Evangeline P, Ramalakshmi V, Rk Karpagam
Department of General Surgery, Sree Balaji Medical College and Hospital, Chennai, IND.
Department of Radiology, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences (SIMATS) Saveetha University, Chennai, IND.
Cureus. 2024 Nov 5;16(11):e73090. doi: 10.7759/cureus.73090. eCollection 2024 Nov.
Introduction Cellulitis is a prevalent bacterial skin infection, particularly affecting the lower limbs and often necessitating clinical intervention due to its considerable incidence rate. Factors like venous insufficiency, lymphedema, and recurring episodes increase the risk of relapse, complicating treatment strategies. Although antibiotics and limb elevation are standard care, severe cases may require surgical intervention. This study investigates subcutaneous pressure as a potential biomarker to assess the severity of lower limb cellulitis and its association with the need for surgical intervention. Methods This observational study was conducted at Sree Balaji Medical College and Hospital, Chennai, involving 105 patients from January 2023 to January 2024 for a duration of one year. Participants were selected based on specific inclusion and exclusion criteria, focusing on adults with unilateral cellulitis below the knee. Subcutaneous pressure was measured using a Stryker intracompartmental pressure monitor, and limb circumference was measured for both the affected and healthy legs. Statistical analysis was performed using paired t-tests, Mann-Whitney U tests, and Levene's test to assess the differences between treatment groups. Results The study found that participants aged 36-45 years constituted the largest proportion (25, 23.8%), and males represented 57.1% of the sample. The most frequent clinical signs were pain (30, 28.57%) and swelling (25, 23.81%). Common comorbidities included diabetes mellitus (30, 28.6%) and venous insufficiency (25, 23.8%). Significant differences were observed between cellulitic and normal legs regarding circumference (p=0.003) and subcutaneous pressure (p=0.003). Patients who underwent surgical intervention showed a greater reduction in symptoms at discharge (1, 2.44%) compared to those receiving only antibiotics (9, 14.06%). Conclusion Elevated subcutaneous pressure correlates strongly with disease severity and the likelihood of requiring surgical intervention in lower limb cellulitis. Patients undergoing surgery had faster recoveries and fewer residual symptoms at discharge. Measuring subcutaneous pressure can be a useful tool in clinical decision-making, potentially improving outcomes and reducing complications in severe cellulitis cases.
引言
蜂窝织炎是一种常见的细菌性皮肤感染，尤其好发于下肢，因其发病率较高，常需临床干预。静脉功能不全、淋巴水肿和反复发作等因素会增加复发风险，使治疗策略变得复杂。尽管抗生素治疗和抬高患肢是标准治疗方法，但严重病例可能需要手术干预。本研究调查皮下压力作为一种潜在生物标志物，以评估下肢蜂窝织炎的严重程度及其与手术干预需求的关联。
方法
本观察性研究在金奈的斯里·巴拉吉医学院和医院进行，从2023年1月至2024年1月为期一年，纳入105例患者。参与者根据特定的纳入和排除标准进行选择，重点是单侧膝下蜂窝织炎的成年人。使用史赛克骨筋膜室压力监测仪测量皮下压力，并测量患侧和健侧腿部的周长。采用配对t检验、曼-惠特尼U检验和莱文检验进行统计分析，以评估治疗组之间的差异。
结果
研究发现，年龄在36 - 45岁的参与者占比最大（25例，23.8%），男性占样本的57.1%。最常见的临床症状是疼痛（30例，28.57%）和肿胀（25例，23.81%）。常见的合并症包括糖尿病（30例，28.6%）和静脉功能不全（25例，23.8%）。蜂窝织炎腿部与正常腿部在周长（p = 0.003）和皮下压力（p = 0.003）方面存在显著差异。与仅接受抗生素治疗的患者（9例，14.06%）相比，接受手术干预的患者出院时症状减轻更为明显（1例，2.44%）。
结论
皮下压力升高与下肢蜂窝织炎的疾病严重程度和手术干预可能性密切相关。接受手术的患者恢复更快，出院时残留症状更少。测量皮下压力可成为临床决策中的有用工具，有可能改善严重蜂窝织炎病例的治疗结果并减少并发症。
