What are the roles of aspiration, dissection, and biopsy in the workup of cellulitis?

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

Needle aspiration should be performed only in selected patients and/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] By contrast, 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. Tissue stains and microscopy reveal findings of soft-tissue inflammation. Leukocyte infiltration, capillary dilatation, and bacterial invasion of tissue are observed.


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