Chronic Cellulitis: Causes and Treatments for Your Father's Condition

I am very unfilial?

Hello Doctor: My father had a major car accident 32 years ago, and he has an artificial bone in his left leg.
However, there is a large dark area on his tibia (shin) that has cellulitis, which flares up occasionally.
He needs to take broad-spectrum antibiotics? Which medication should he take? If it gets severe, he may need to be hospitalized! I would like to ask if the cellulitis on my father's tibia is a consequence of the major car accident that occurred 32 years ago? Additionally, since his left leg is the affected one, he cannot touch it, and when it itches, he rubs it with the heel of his right foot, which has caused skin abrasions (not just one area).
Besides some bleeding, there is also a yellowish fluid oozing out, forming yellow scabs.
I would like to know why this is happening? What condition could this be? Furthermore, on the side of his right ankle, just above it, he sustained a wound from being hit by a car a few days ago, but no matter how we apply medication, it does not heal or form new skin.
He has seen a plastic surgeon who confirmed there is no debris inside, and they applied artificial skin, but it still hasn't improved.
One surgeon said that cellulitis wouldn't occur there; another surgeon said that if we apply medication for another two weeks, the wound would still not heal! What is going on with my father? Is cellulitis the culprit? Thank you for your response.

Zhao Zilong, 30~39 year old female. Ask Date: 2013/09/12

Dr. Huang Zhihui reply Surgery

Older adults often experience poor blood circulation in their extremities, making them more susceptible to soft tissue infections when bacteria invade, a condition known as cellulitis.
This risk is heightened in individuals with a history of significant injuries or those with implanted medical devices.
The anterior aspect of the lower leg has less subcutaneous tissue, resulting in even poorer circulation; thus, injuries in this area frequently lead to delayed skin healing, often causing exudate from the wound.
During the healing process, patients may experience itching, prompting them to scratch, which can further damage the skin.
This creates a vicious cycle that complicates recovery.
Therefore, it is essential to keep the wound clean and avoid bacterial infections, as well as refrain from scratching the wound or newly formed skin, to naturally prevent cellulitis and promote healing.
If the wound exhibits redness, swelling, heat, pain, or fails to heal, it is advisable to consult a physician.

Reply Date: 2013/09/12

More Info

Chronic cellulitis is a persistent skin infection that can be particularly challenging to manage, especially in patients with a history of trauma or surgery, as in your father's case. Given that he suffered a significant car accident 32 years ago and has an artificial bone in his left leg, it is plausible that the chronic cellulitis he experiences could be related to the initial injury and subsequent complications.

Cellulitis typically arises when bacteria enter the skin through a break or crack, leading to inflammation and infection. In your father's situation, the presence of an artificial bone may create a unique environment that predisposes him to recurrent infections. The blackened area on his tibia could indicate chronic inflammation or necrosis, which might make the skin more susceptible to bacterial invasion. Additionally, the scratching and irritation caused by his attempts to relieve itching can further compromise the skin barrier, allowing bacteria to enter more easily.

The yellow fluid and crusting you describe suggest that there may be an ongoing infection or a secondary issue, such as a skin ulcer or a chronic wound. The fact that the area is not healing properly could be due to several factors, including poor blood circulation, the presence of foreign material (like the artificial bone), or even underlying conditions such as diabetes or vascular disease, which can impair healing.

As for the right ankle wound that is not healing, it is essential to consider that wounds can become chronic for various reasons, including inadequate blood supply, infection, or improper wound care. The differing opinions from the plastic and general surgeons indicate that there may be some confusion regarding the diagnosis. While cellulitis typically presents with redness, swelling, and warmth, it may not always be the sole cause of non-healing wounds.
In terms of treatment, broad-spectrum antibiotics are often prescribed for cellulitis, but the choice of medication should be guided by the severity of the infection and any underlying health conditions. It is crucial for your father to follow up with a healthcare provider who can assess the situation comprehensively. A wound care specialist may also be beneficial in managing the chronic wound on his right ankle, as they can provide targeted therapies to promote healing.

Given the complexity of your father's condition, it may be wise to seek a second opinion from a specialist in infectious diseases or a vascular surgeon. They can provide a more in-depth evaluation of his chronic cellulitis and non-healing wounds, considering his medical history and current symptoms.

In summary, your father's chronic cellulitis and non-healing wounds are likely interconnected with his past trauma and the presence of an artificial bone. Proper management will require a multidisciplinary approach, including appropriate antibiotic therapy, wound care, and possibly addressing any underlying conditions that may be contributing to his symptoms. It is essential to maintain open communication with healthcare providers and advocate for comprehensive care to ensure the best possible outcomes for your father's health.

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