Management of Subcutaneous Emphysema with “Gills”: Case Report and Review of the Literature

Kiefer, Matthew V.; Feeney, Colin

doi:10.1016/j.jemermed.2013.04.052

Cited by 11 publications

(14 citation statements)

References 24 publications

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“…Historically, treatment of subcutaneous emphysema has ranged from observation alone to the addition of high-flow inspired oxygen, increasing suction, 11,14 placement of intravenous cannulae or small-bore chest drains to the subcutaneous space, 15 placement of multiple additional intercostal catheters in the pleural space, loose closure of generous incisions, nonocclusive dressing of wounds, 15 laying open superficial layers of previous incisions, and finally return to the operating room for surgical management. More recently, negative-pressure wound therapy vacuum dressing placement to prior or new incisions has been popular, which in the absence of an undrained pneumothorax, often is successful without the need to reenter the pleural cavity.…”

Section: Discussionmentioning

confidence: 99%

Life-Threatening Laryngeal Emphysema After Video-Assisted Thoracoscopic Surgery

Louis

Graham

Spanger

et al. 2020

Journal of Cardiothoracic and Vascular Anesthesia

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Section: Discussionmentioning

confidence: 99%

Life-Threatening Laryngeal Emphysema After Video-Assisted Thoracoscopic Surgery

Louis

Graham

Spanger

et al. 2020

Journal of Cardiothoracic and Vascular Anesthesia

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“…When compression of vital structures is noted in the neck, pleural drains and infraclavicular “gill” incisions have been reported in case studies to evacuate the subcutaneous gas [27, 28]. There have also been case reports of management with a subcutaneous negative-pressure drain [29–31].…”

Section: Discussionmentioning

confidence: 99%

A Case Report of Acute Airway Compromise due to Subcutaneous Emphysema

Olmstead

Gelfand

Anderson

et al. 2018

Case Reports in Medicine

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In the acute management of a trauma patient, airway patency is of utmost importance. The present case describes a male patient who presented with delayed severe upper airway obstruction secondary to massive subcutaneous emphysema following blunt traumatic injury two days previously. Airway compromise is a rarely described but serious complication of subcutaneous emphysema. Current management of subcutaneous emphysema and its association with pneumothorax is summarized. Early decompression of underlying pneumothoraces in patients with significant subcutaneous emphysema should be performed to avoid this rare complication.

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“…Other authors recommend managing SE using the "gills" procedure, consisting of bilateral skin incisions over the clavicles (10) or alternatively, with the placement of VAC (11). In these cases, SE was effectively treated with local negative pressure therapy applied to a subfascial incision.…”

Section: Discussionmentioning

confidence: 99%

Recalcitrant Subcutaneous Emphysema: A Solution with A Simple Method

Gaviria¹,

Díaz²,

Pérez-warnisher³

et al. 2017

Eurasian J Pulmonol

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Subcutaneous emphysema (SE) represents a frequent problem in thoracic surgery. It is caused by an air leak from the lung, causing accumulation of air in the subcutaneous tissues and creating a painless swelling of the skin. This migration of air is facilitated by many factors, including intermittently high positive intrapleural pressure, coughing, lung hyperinflation, inadvertent kinking or angulation of the chest drain, or by a combination of all four factors (1). Although it is rarely lethal, it causes esthetic deformity, anxiety, and voice alterations, all of which increase patient morbidity. It has the potential to compress both, the trachea and the great vessels, resulting in airway compromise, limiting venous return, and causing venous congestion of the head and neck (2). In rare cases, tracheostomy or intubation is required (3).The method that we propose can be used to resolve the symptoms, esthetic consequences, and the loss of comfort that can affect patients following thoracic surgery. Recalcitrant emphysema leads to physical deformation that can sometimes even lead to patients not being recognized by their own family due to the excessive accumulation of air in the subcutaneous tissues of the face and neck. This ultimately causes anxiety and discomfort for both, the patient and their relatives. AbstractObjective: To report our experience in treating 10 consecutive patients with recalcitrant subcutaneous emphysema (SE) using two different types of subcutaneous drains. Methods:A retrospective review of our experience in managing 10 cases of recalcitrant SE. The method that we employed consisted of creating a subcutaneous tunnelization of the pre-pectoral space, under previous local anesthesia, and inserting three Penrose drains (small rubber tubes) or a multifenestrated Argyle drain in the tunnels. Results:The placement of the subcutaneous drains resolved SE in all 10 cases within a mean time of 5.3 days. No local or systemic complications were observed, but patients with the Argyle drain showed worse tolerance, presenting local pain that required treatment with additional analgesics. Conclusion:The subcutaneous drain treatment of the recalcitrant SE is a simple, safe, and effective method that should be used in clinical practice for the better comfort of patients. In our series, Penrose drains were better tolerated than the multifenestrated Argyle drains.

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Management of Subcutaneous Emphysema with “Gills”: Case Report and Review of the Literature

Cited by 11 publications

References 24 publications

Life-Threatening Laryngeal Emphysema After Video-Assisted Thoracoscopic Surgery

Life-Threatening Laryngeal Emphysema After Video-Assisted Thoracoscopic Surgery

A Case Report of Acute Airway Compromise due to Subcutaneous Emphysema

Recalcitrant Subcutaneous Emphysema: A Solution with A Simple Method

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