Indications for surgery

Antibiotics alone may be unable to control infection and it is necessary to decide whether adjunctive surgery is necessary. In severe episodes of cellulitis, the ulcer may be complicated by extensive infected subcutaneous soft tissue. At this point, the tissue is not frankly necrotic but has started to break down and liquefy. It is best for this tissue to be removed operatively. The definite indications for urgent surgical intervention are:

• A large area of infected sloughy tissue

• Localized fluctuance and expression of pus

• Crepitus with gas in the soft tissues on X-ray

• Blue or purplish discolouration of the skin.

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