What is the role of debridement in the workup and treatment of cellulitis, and what are the histologic findings?

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

In cases in which cellulitis is extensive and tissue is no longer viable, debridement may be performed. In such cases, the normally bright-yellow fat becomes hemorrhagic and necrotic (see the first image below). Microscopic evaluation shows clusters of neutrophils (acute inflammation) invading adipose tissue, which can produce fat necrosis if it is extensive enough (see the second image below). An abscess forms when neutrophils aggregate into large clusters. Rarely, organisms can be seen on routine histologic stains (see the third image below).

Hematoxylin and eosin (H&E) stain, high power. Thi Hematoxylin and eosin (H&E) stain, high power. This image shows cellulitis caused by herpes simplex virus, with the multinucleated organism in the center of the picture.
Hematoxylin and eosin (H&E) stain, high power. Thi Hematoxylin and eosin (H&E) stain, high power. This image shows deeper subcutaneous tissue involved in a case of cellulitis, with acute inflammatory cells and fat necrosis.
Gross photograph of complicated cellulitis. Instea Gross photograph of complicated cellulitis. Instead of the presence of yellow fat, the tissue is hemorrhagic and necrotic.

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