Management of extensive subcutaneous emphysema using vacuum-assisted closure therapy

Sindi, Dalia; Mirza, Abdurrahman; Khirallah, Mohammad Gharieb; Bustangi, Nasir

doi:10.1016/j.epsc.2019.101272

Cited by 1 publication

(5 citation statements)

References 7 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the use of closed incision NPWT (ciNPWT) and PICO © device were reported. Most articles (n=6/10) described a small infraclavicular blowhole incision technique, creating a prepectoral pocket to insert the NPWT foam (9)(10)(11)(15)(16)(17). The incision lengths differed from 2 to 6 cm.…”

Section: Study Characteristics Methodsmentioning

confidence: 99%

“…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).…”

Section: Study Characteristics Methodsmentioning

confidence: 99%

“…Set pressures of the NPWT device varied from 50 to 150 mmHg. Only one article did apply a pressure <100 mmHg (9); two articles did not report pressure rates including Prakash et al reporting the PICO © technique (13,17). Sufficient air drainage was reached with the abovementioned suction pressures in all cases and no pressure adjustments were made.…”

Section: Study Characteristics Methodsmentioning

confidence: 99%

“…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).…”

Section: Study Selectionmentioning

confidence: 99%

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

Janssen¹,

Laven²,

Daemen³

et al. 2022

J Thorac Dis

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Background: Massive subcutaneous emphysema can cause considerable morbidity with respiratory distress.To resolve this emphysema in short-term, negative pressure wound therapy could be applied as added treatment modality. However, its use is sparsely reported, and a variety of techniques are being described.This study provides a systematic review of the available literature on the effectiveness of negative pressure wound therapy as treatment for massive subcutaneous emphysema. In addition, our institutional experience is reported through a case-series. Methods: The PubMed, Embase and Cochrane Library were systematically searched for publications on the use of negative pressure wound therapy for subcutaneous emphysema following thoracic surgery, trauma or spontaneous pneumothorax. Moreover, patients treated at our institution between 2019 and 2021 were retrospectively identified and analyzed. Results:The systematic review provided 10 articles presenting 23 cases. Studies demonstrated considerable heterogeneity regarding the location of incision, creation of prepectoral pocket, and surgical safety margin. Also closed incision negative pressure wound therapy and PICO © device were discussed. Despite the apparent heterogeneity, all techniques provided favorable outcomes. No complications, reinterventions or recurrences were documented. Furthermore, retrospective data of 11 patients treated at our clinic demonstrated an immediate response to negative pressure wound therapy and a full remission of the subcutaneous emphysema at the end of negative pressure wound therapy. No recurrence requiring intervention or complications were observed. Conclusions:The findings of this study suggest that negative pressure wound therapy, despite the varying techniques employed, is associated with an immediate regression of subcutaneous emphysema and full remission at the end of therapy. Given the relatively low sample size, no technique of choice could be identified. However, in general, negative pressure wound therapy appears to provide fast regression of subcutaneous emphysema and release of symptoms in all cases.

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