Recalcitrant Subcutaneous Emphysema: A Solution with A Simple Method

Abstract

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.