Variability in the Application and Principles of Prehabilitation and Enhanced Recovery (VAPPER Survey) Among Colorectal Surgery Units: A National Multicentre Survey.

We searched PubMed, Embase and Web of Science for studies published from database inception to June 1, 2017, using the search terms “cellulitis”, “erysipelas”, and “compression”, along with common synonyms. Reference lists of relevant articles were also screened. Only two articles were identified, both reporting before-and-after studies of Complete Decongestive Therapy (CDT), which combines compression therapy with skin care, exercise and manual lymphatic drainage, in patients with arm or leg lymphoedema. Arsenault and colleagues reported that, among 10 of 21 enrolled participants with follow-up data to 18 months, the cumulative annual incidence rate of hospitalisation for recurrent cellulitis reduced from 8·5 to 0·67 admissions per year. Ko and colleagues found that among 299 consecutively recruited participants, the incidence of cellulitis was reduced from 1·10 to 0·65 infections per patient per year. Cellulitis prevention research has mainly focused on antibiotic prophylaxis, with few studies on modifying known risk factors such as chronic oedema. Consistent with our search findings, a 2017 Cochrane systematic review, , included no randomised trials evaluating risk factor modification, despite their key role in cellulitis pathogenesis. Together, these findings demonstrate a substantial evidence gap and highlight the need for randomised trials evaluating chronic oedema management and other risk factor modification strategies for the prevention of recurrent cellulitis. The Cochrane review similarly recommended incorporating such strategies into cellulitis prevention programmes and called for trials evaluating their efficacy.