What is the procedure called when making a few superficial incisions to reduce swelling in a patient with leg cellulitis?

Making Superficial Incisions in Leg Cellulitis is NOT Standard Practice

The procedure you are describing—making superficial incisions to reduce swelling in cellulitis—is not a recognized or recommended treatment for uncomplicated cellulitis and should be avoided. 1, 2

Why This Practice is Problematic

• Cellulitis is managed with antibiotics, not incisions. The Infectious Diseases Society of America clearly states that cellulitis (an infection of the deep dermis and subcutaneous tissue) should be treated with antibiotics targeting streptococci and methicillin-sensitive Staphylococcus aureus, such as penicillin, amoxicillin, cephalexin, or dicloxacillin for 5 days. 1, 2

• Incision and drainage is ONLY indicated for abscesses, not cellulitis. The 2018 WSES/SIS-E consensus explicitly states that "incision and drainage is the primary treatment for simple abscesses or boils," but cellulitis without abscess formation requires antibiotic therapy alone. 1

• Making incisions in cellulitis can worsen outcomes. Introducing breaks in the skin barrier during active infection increases the risk of deeper tissue involvement, bacteremia, and progression to necrotizing fasciitis. 1

What You May Be Confusing This With

If There is an Abscess Present:

• The procedure is called "incision and drainage" (I&D). This involves making an incision to drain a well-circumscribed collection of pus, not superficial incisions for swelling reduction. 1, 3

If There is Necrotizing Fasciitis:

• The procedure is called "surgical debridement" or "fasciotomy." This involves extensive incisions through skin and fascia to remove necrotic tissue and decompress compartments, but this is for life-threatening necrotizing infections, not simple cellulitis. 1

• Necrotizing fasciitis requires aggressive surgical exploration with debridement, often requiring return to the operating room every 24-36 hours until no further necrosis is found. 1

If There is Compartment Syndrome:

• The procedure is called "fasciotomy." This involves deep incisions through fascia to relieve pressure in muscle compartments, but this is for vascular compromise, not infection management. 1

Correct Management of Leg Cellulitis

• Elevation of the affected leg is the appropriate non-pharmacologic intervention to reduce swelling by promoting gravitational drainage of edema and inflammatory exudate. 2, 4

• Oral antibiotics for 5 days targeting streptococci (penicillin, amoxicillin, cephalexin, or dicloxacillin) are sufficient if clinical improvement occurs. 1, 2

• Hospitalization with IV antibiotics is required only if systemic signs are present (fever >38.5°C, heart rate >110 bpm, hypotension, altered mental status, or signs of necrotizing infection). 2

• Address predisposing factors such as tinea pedis, venous insufficiency, lymphedema, and obesity to prevent recurrence. 2, 4

Critical Red Flags Requiring Surgical Consultation

• Failure to respond to appropriate antibiotics after 48-72 hours suggests deeper infection requiring surgical exploration. 1

• Hard, woody feel of subcutaneous tissue extending beyond visible erythema indicates possible necrotizing fasciitis. 1

• Bullous lesions, skin necrosis, or ecchymoses are signs of tissue necrosis requiring immediate surgical debridement. 1

• Gas in soft tissues on imaging or palpation mandates urgent operative drainage and debridement. 1