When are aspiration, dissection, and biopsy suggested for cellulitis?

Updated: Jun 14, 2019
  • Author: Thomas E Herchline, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Aspiration, Dissection, and Biopsy

  • Needle aspiration should be performed only in selected patients or in unusual cases, such as in cases of cellulitis with bullae or in patients who have diabetes, are immunocompromised, are neutropenic, are not responding to empiric therapy, or have a history of animal bites or immersion injury [8, 9, 10]

  • Aspiration or punch biopsy of the inflamed area may have a culture yield of 2-40% and is of limited clinical value in most cases [11]

  • Gram stain of aspiration or biopsy specimens has a low yield and is unnecessary in most cases, unless purulent material is draining or bullae or abscess is present; however, Gram stain and culture following incision and drainage of an abscess yields positive results in more than 90% of cases [2]

  • Dissection of the underlying fascia to assess for necrotizing fasciitis may be determined by surgical consultation or indicated following initial evaluation and imaging studies [12]

  • Skin biopsy is not routine but may be performed in an attempt to rule out a noninfectious entity


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