Negative-pressure in treatment of persistent post-traumatic subcutaneous emphysema with respiratory failure: Case report and literature review

Abstract

Subcutaneous emphysema may aggravate traumatic pneumothorax treatment, especially when mechanical ventilation is required. Expectative management usually suffices, but when respiratory function is impaired surgical treatment might be indicated. Historically relevant methods are blowhole incisions and placement of various drains, often with related wound complications. Since the first report of negative pressure wound therapy for the treatment of severe subcutaneous emphysema in 2009, only few publications on use of commercially available sets were published. We report on patient injured in a motor vehicle accident who had serial rib fractures and bilateral pneumothorax managed initially in another hospital. Due to respiratory deterioration, haemodynamic instability and renal failure patient was transferred to our Intensive Care Unit. Massive and persistent subcutaneous emphysema despite adequate thoracic drainage with respiratory deterioration and potentially injurious mechanical ventilation with high airway pressures was the indication for active surgical treatment. Negative-pressure wound therapy dressing was applied on typical blowhole incisions which resulted in swift emphysema regression and respiratory improvement. Negative pressure wound therapy for decompression of severe subcutaneous emphysema represents simple, effective and relatively unknown technique that deserves wider attention.

Extensive clostridial myonecrosis after gluteal intramuscular injection in immunocompromised patient treated with surgical debridement and negative-pressure wound therapy

“…Less edema means less intercellular fluid which shortens the path between the vessels and the target cells. NPWT is routinely applied in chronic wounds and pressure ulcers but it has versatile use such as rapid air collections removal in recalcitrant post-traumatic subcutaneous emphysema [ 5 ]. Our case shows efficiency of NPWT on large wound with significant tissue loss, allowing gradual closure in a short time period without the need for skin grafting.…”

Management of extensive subcutaneous emphysema using negative pressure wound therapy dressings

“…Currently, there are no large‐scale studies or randomized controlled trials to compare efficacy and success rates of NPWTDs for SE. Whilst some described cases involved deep blowhole incisions up till the pectoral fascia , our patient was subjected to a less invasive procedure, with only breach of the subcutaneous layer. Our technique involved only the simplest of tools and can therefore be employed effectively, even in resource‐limited settings.…”

How to create negative pressure wound dressing with wall suction: novel treatment of subcutaneous emphysema with PICO dressing

“…Its new portable single‐use variant is the PICO (Smith & Nephew, London, UK), which does not require a disposable canister but absorbs the exudates into the dressing 2 . In recent years, NPWT has been used in the management of SSE in conjunction with infraclavicular ‘blowhole’ incisions 3 …”

“…Subcutaneous emphysema (SE) is usually an asymptomatic condition. 3,4 It is prevalent in males with an incidence rate of 2.43% presenting at around 54 years of age. 4 The most common causes are chest trauma, thoracic surgery and secondary pneumothorax.…”