High negative pressure subcutaneous suction drain for managing debilitating subcutaneous emphysema secondary to tube thoracostomy for an iatrogenic post computed tomography guided transthoracic needle biopsy pneumothorax: Case report and review of literature

Ahmed, Zunirah; Patel, Pinakin; Sharma, Reetika; Somani, Pankaj; Gouri, Abdul Rauf; Singh, Suresh

doi:10.1016/j.ijscr.2016.07.031

Cited by 13 publications

(15 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There are reports of successful use of adapted 12F (Seldinger) drains inserted i) unilaterally in the axilla and connected to a drain with -5cmH20 (-0.5kPa) suction [40•] with resolution at 5 days and ii) in the infraclavicular areas bilaterally with application of -150 mmHg (-20kPa) suction and manual decompression leading to resolution at 5 days [41]. Wider 26F and 28F drains have also been tunnelled subcutaneously with reported successful relief of SCE.…”

Section: Draining the Subcutaneous Emphysema Via Subcutaneous Drainsmentioning

confidence: 99%

The Management of Subcutaneous Emphysema in Pneumothorax: A Literature Review

Melhorn

Davies

2021

Curr Pulmonol Rep

View full text Add to dashboard Cite

Purpose of Review Subcutaneous emphysema is often observed by clinicians in the context of pneumothorax. It is usually clinically insignificant, but in a few cases can progress to threaten the patient’s vision or airway. A variety of approaches to management of such cases are described in the literature. There no controlled trials and no guidelines on management, other than that the cause should be identified and treated wherever possible. The goal of this article is to review the described approaches to subcutaneous emphysema in pneumothorax and provide a reference to the clinician. Summary Treatment can be directed primarily towards treating an underlying pneumothorax and / or towards the subcutaneous emphysema. These are not mutually exclusive approaches. Management of the underlying pneumothorax includes conservative management; use of negative suction; siting of wider bore intercostal drains and definitive surgical management. Management of subcutaneous emphysema may include decompression techniques such as: ‘blow hole’ incisions or subcutaneous angio-catheters or tunnelled drains. In the current absence of controlled trials is not possible to comment on the efficacy of these techniques: no recommendations on management of subcutaneous emphysema in pneumothorax can be made. Management will be significantly influenced by local technical expertise and patient factors for the foreseeable future.

show abstract

Section: Draining the Subcutaneous Emphysema Via Subcutaneous Drainsmentioning

confidence: 99%

The Management of Subcutaneous Emphysema in Pneumothorax: A Literature Review

Melhorn

Davies

2021

Curr Pulmonol Rep

View full text Add to dashboard Cite

show abstract

“…This case reports the first use of palpebromalar “fish gill’ incisions for successful resolution of severe cervical, fascial and periorbital surgical emphysema which occur following chest drain insertion for tension pneumothorax. Previously, such cases have often been described in the context of dental 4 or facial surgical procedures 5 and facial trauma, with only a handful of cases following iatrogenic factors such as chest drain insertion or other thoracic procedures 2 . Immediate intervention should be considered due to the risk of cardiovascular compromise.…”

Section: Discussionmentioning

confidence: 99%

“…Causes include injury to the thoracic cavity or bowel, infection or iatrogenic factors, including chest drain insertion 1 . Extensive surgical emphysema may develop as air tracks along the fascial planes from the site of origin to the face and periorbital region 2 and, in severe cases, may result in respiratory or cardiovascular compromise 3 . As such, treatment is indicated to alleviate discomfort, restore sight and reduce the risk of tension physiology.…”

Section: Introductionmentioning

confidence: 99%

“Fish Gill” Incisions for Severe Periorbital Surgical Emphysema Following Tension Pneumothorax – A Case Report and Review of the Literature

Patel

Barabas

2021

JPRAS Open

View full text Add to dashboard Cite

Background Surgical emphysema refers to the presence of air within the subcutaneous space and is a known complication of chest drain insertion. Symptoms range from mild crepitus of the chest wall to the accumulation of air in the face and neck, which can ultimately result in cardiovascular compromise. Objective The aim of this article is to present a rare case of cervical, facial and periorbital surgical emphysema following chest drain insertion, and describes a novel use of ‘fish gill’ incisions in the palpebromalar groove with an associated review of the literature. Case Report A 68-year-old gentleman presented with acute dyspnoea due to a right-sided tension pneumothorax. Emergency decompression with a Seldinger chest drain resulted in persistent cervical, facial and periorbital surgical emphysema causing difficulty in movement, inability to open the eyes and progressive risk to cervical venous return. “Fish gill’ incisions at the lateral-most edge of the palpebromalar groove, down to the level of the orbicularis oculi muscle, rapidly released air from the face and neck, alleviating discomfort, reducing venous compression and restoring vision. Conclusion Cervical, fascial and periorbital surgical emphysema may be resolved with the use of “fish gill” incisions at the lateral palpebromalar groove and simple drains. To the best of our knowledge, this method has not been reported previously in the literature.

show abstract

“…Ahmed et al had combined these techniques using a 12 Fr. subcutaneous infraclavicular drain on continuous high suction at −150 mmHg aided by manual decompressive massage [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…On occasions it can be extensive, rapidly increasing, disfiguring and life threatening which require intervention. As described by Srivanas et al, extensive surgical emphysema can be a debilitating form causing palpable cutaneous tension, dysphagia, dysphonia, palpebral closure or associated with pneumoperitoneum, airway compromise, “tension phenomenon” and respiratory failure [ 2 , 3 ]. Here a case of extensive surgical emphysema treated with subcutaneous drain is reported in line with the SCARE criteria [ 4 ].…”

Section: Introductionmentioning

confidence: 99%