By Carol A. Kemper, MD, FACP

Clinical Associate Professor of Medicine, Stanford University, Division of Infectious Diseases, Santa Clara Valley
Medical Center

SOURCE: Webb E, Neeman T, Bowden FJ, et al. Compression therapy to prevent recurrent cellulitis of the leg. N Engl J Med 2020;363:630-639.

Webb et al examined the benefit of compression garments in patients with lower extremity edema at risk for cellulitis. Eligible patients reported significant edema for more than three months in one or both legs, and a history of two or more episodes of cellulitis in the same leg within the previous two years. They could not be using compression garments already for more than four days per week. Patients who were at end of life or immunosuppressed were excluded.

Participants were assigned to wear compression garments throughout the day, every day. The garments generally consisted of knee-high stockings including the foot (with or without the toes) or leg and foot wraps. Participants were followed every six months for up to three years. Control patients who developed cellulitis were crossed over to the compression therapy group. Clinical characteristics were similar between the two groups at entry to the study. A total of 84 participants were enrolled in study, including 41 in the compression group. During the study, 78% of participants in the compression group reported wearing their stockings or wraps five or more days per week, and 88% reported using them at least four days per week.

The trial ended prematurely when the authors recognized a large difference in outcomes between the two groups. At the time the study ended, 23 episodes of cellulitis had occurred, including six in the compression therapy group and 17 in the control group (P = 0.002). Three patients in the compression group and six in the control group required hospitalization. Three patients died (one in the compression group and two in the control group), and one in each group developed wound infection. Two patients in each group were receiving prophylactic antibacterials at the time of study entry, which were continued. The median duration of follow-up was 209 days in the compression group and 77 days in the control group — simply because patients were removed from the control group when they developed cellulitis.