Management of extensive subcutaneous emphysema using negative pressure wound therapy dressings

Abstract

Subcutaneous emphysema (SE) is a common but usually self‐limiting complication of cardiothoracic procedures. Rarely, it can be life threatening and is characterized by extensive cutaneous tension and airway compromise requiring immediate intervention. There is a paucity of data on the most efficacious treatment methods for extensive SE. We report an 80‐year‐old gentleman who developed massive SE necessitating intubation for airway protection following a right chest tube insertion for spontaneous secondary pneumothorax. His SE persisted despite adequate thoracic drainage via a new chest tube. It was then decided to insert two negative pressure wound therapy dressings (NPWTD) or vacuum dressings in the patient's subcutaneous tissue layer via incisions made at anterior chest wall. The dressings were removed after four days in view of significant improvements. NPWTD appears to be an effective, well‐tolerated, safe, and inexpensive approach that hastens the resolution of SE without the need for invasive thoracic surgeries.

Extensive subcutaneous emphysema treated with subcutaneous angiocatheters

“…The presence of extensive SCE warrants emergent intervention to decompress the subcutaneous tissue 4–7 . Several novel techniques have been described to achieve this goal, each with advantages and disadvantages.…”

Negative pressure wound therapy for massive subcutaneous emphysema: a systematic review and case series

“…The first description of a blowhole incision with the use of NPWT for the treatment of massive subcutaneous emphysema was by Sciortino et al in 2009; whereupon several other small case series followed (8)(9)(10)(11)(12)(13)(14)(15)(16)(17). Conventional blowhole incisions were widely used before.…”

“…The incision lengths differed from 2 to 6 cm. In five cases a blowhole incision was not only placed on the affected body half but also on the contralateral side while the clinician felt it was necessary for adequate treatment given the extent of emphysema (8,10,16,17). In three patients the incision was placed supraclavicular, based on the severity and location of the subcutaneous emphysema (10).…”

“…They placed the incision 5cm below the clavicle and 5cm from the sagittal midline. They also assured that the incision was placed at the superior border of the underlying rib (8). Furthermore, the article by Towe et al recommended a safety margin between the clavicle and the incision, keeping at least 4 cm space in between (11).…”

“…In addition, from another three articles only the abstract was available. The remainder of 10 articles were included, describing a total of 23 unique cases (8)(9)(10)(11)(12)(13)(14)(15)(16)(17).…”