Sustained benefit of compression therapy for preventing recurrent leg cellulitis: extended follow-up of a randomised controlled trial
Compression therapy durably reduced recurrent leg cellulitis in adults with chronic leg swelling.
*Open-label randomized controlled trial with extended follow-up; Level 1b.
Citation
Webb E, Neeman T, Bowden FJ, Gaida J, Mumford V, Bissett B. eClinicalMedicine. 2026;98:104127. doi:10.1016/j.eclinm.2026.104127
Background
Recurrent leg cellulitis causes repeated illness, hospital use, and antibiotic exposure. Chronic leg swelling is a major modifiable risk factor, but swelling-focused prevention has been underused.
Patients
90 Australian adults with chronic leg swelling for at least 3 months and at least 2 cellulitis episodes in the same leg within 2 years. Exclusions included effective current compression use, contraindication to compression, end-of-life care, unstable illness, or specialist-managed chronic wounds.
Intervention
Cellulitis prevention education plus individualized fitted compression garments, worn during waking hours.
Control
Cellulitis prevention education alone; compression was later offered after early trial stopping for benefit.
Outcome
Primary: time to first recurrent cellulitis. Secondary: cellulitis-related hospital admission, leg volume, and quality of life.
Follow-up Period
Median 18 months.
Results
| Outcome | Compression | Control | Effect |
|---|---|---|---|
| Recurrent cellulitis (primary) | 9/45 (20%) | 21/45 (47%) | HR 0.23 (95% CI 0.10 to 0.52); NNT 4 |
| Hospitalization for recurrent cellulitis | 4/45 (9%) | 8/45 (18%) | HR 0.25 (95% CI 0.07 to 0.90); NNT 12 |
HR = hazard ratio; NNT = number needed to treat.
Analyses were by intention to treat. Adherence was high: 85% wore garments at least 4 days weekly. The control was education-only, not active compression. This was not a non-inferiority trial.
Limitations
Single-center, open-label trial stopped early for benefit. Crossover limited longer randomized comparison. Cellulitis diagnosis and adherence partly relied on participant report. Findings apply best to higher-risk adults with chronic leg swelling and recurrent leg cellulitis; benefit may be smaller in lower-risk patients.
Funding
Haddenham Healthcare provided garments; funders had no data role.
Clinical Application
Offer fitted compression therapy to patients with chronic leg swelling and recurrent leg cellulitis, alongside skin care and risk-factor management.
Discussion
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In this open-label randomized controlled trial extended follow-up, compression therapy reduced recurrent leg cellulitis from 47% to 20% (HR 0.23; NNT 4); how valid and applicable are these results for changing prevention practice in patients with chronic leg oedema? In this randomized trial, compression therapy was associated with fewer recurrent cellulitis episodes, with an HR of 0.23 and observed recurrence rates of 20% versus 47%. Which statement best explains why reporting both relative and absolute effects is useful?