How should an infected lipoma be treated?

Treatment of Infected Lipoma

The most important therapy for an infected lipoma is to open the incision, evacuate the infected material, and continue dressing changes until the wound heals by secondary intention. 1

Primary Treatment Approach

Incision and Drainage (Mandatory)

• Open the infected wound surgically and evacuate all purulent material – this is the cornerstone of treatment and is more important than antibiotic therapy. 1
• Continue dressing changes until the wound heals by secondary intention. 1
• Most surgical site infections (SSIs) and subcutaneous abscesses show little or no benefit from antibiotics when combined with adequate drainage. 1

When Antibiotics Are NOT Needed

Antibiotics are unnecessary if the patient meets ALL of the following criteria: 1

• Erythema and induration extending <5 cm from the wound
• Temperature <38.5°C
• White blood cell count <12,000 cells/µL
• Pulse <100 beats/minute

When Antibiotics ARE Indicated

A short course (24–48 hours) of antibiotics is required when ANY of the following are present: 1

• Temperature >38.5°C
• Heart rate >110 beats/minute
• Erythema extending >5 cm beyond the wound margins

Antibiotic Selection

For Clean Procedures (No Entry into Mucosal Surfaces)

• Target Staphylococcus aureus and streptococcal species, as these are the most common pathogens in clean surgical sites. 1
• Empiric coverage should address community-acquired MRSA if local prevalence is significant. 1

For Contaminated Sites (Near Intestinal or Genital Tracts)

• Use antibiotics suitable for mixed aerobic-anaerobic flora (e.g., agents appropriate for intra-abdominal infection). 1
• The antibiotic choice should be guided by Gram stain, culture of wound contents, and the anatomic site. 1

Critical Red Flags Requiring Urgent Surgical Consultation

Immediate surgical consultation is mandatory for: 1

• Signs of systemic toxicity
• Suspicion of necrotizing fasciitis
• Suspicion of gas gangrene
• Early postoperative infection (within 48 hours) with wound drainage showing organisms on Gram stain, especially if white blood cells are absent (suggests streptococcal or clostridial infection) 1

Aggressive Infection Management

For necrotizing or aggressive infections, empiric antibiotic treatment must be broad-spectrum and cover polymicrobial pathogens: 1

• Vancomycin or linezolid PLUS
• Piperacillin-tazobactam OR a carbapenem OR ceftriaxone plus metronidazole

Common Pitfalls to Avoid

• Do not rely on antibiotics alone – inadequate drainage is the most common cause of treatment failure. 1
• Do not administer prophylactic antibiotics for simple incision and drainage of superficial abscesses, as bacteremia is rare and no clinical benefit has been demonstrated. 1
• Do not delay opening the wound in patients with systemic signs – early drainage is critical. 1
• Fever within the first 48 hours postoperatively is rarely due to SSI; however, if streptococcal or clostridial infection is suspected based on wound drainage and Gram stain, immediate intervention is required. 1