Treatment of recalcitrant subcutaneous emphysema using negative pressure wound therapy dressings

Abstract

Subcutaneous emphysema frequently occurs after pulmonary resection, but is usually mild and self-limiting. Patients can, however, develop severe symptomatic subcutaneous emphysema despite adequate thoracic drainage. There is a paucity of efficacious treatments for subcutaneous emphysema that does not respond to chest tube drainage. Previous reports have suggested that thoracoscopy may be an efficacious treatment, but is unfavourable due to the risks associated with reoperation. We present a case of a patient who developed severe subcutaneous emphysema after pulmonary lobectomy that was quickly and effectively treated using a commercially available negative pressure wound therapy dressing.

Management of extensive surgical emphysema with subcutaneous drain: A case report

“…Johnson et al and Ahmed et al recently reviewed the various methods described in the literature – mostly small retrospective studies and case reports – to outline the advantages and disadvantages of each technique. Repeated manual decompression via “blow hole” incisions can be cumbersome, while VAC therapy would pose potential cosmetic defect [ 15 ]. Small-bore catheters may be prone to blockage and take longer to resolve.…”

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

“…This technique failed to hasten the process of air extraction with reported mean duration of NPWT of 7.3 ± 4.8 (range 3–14) days which is explained with pathological lung status and the presence of positive-pressure mechanical ventilation [6] . The most recent report on NPWT use for the treatment of recalcitrant SE after thoracoscopic right middle lobe resection causing vision loss and emotional distress, without dyspnoea or respiratory insufficiency was published in October 2014 by Towe and colleagues [7] . Treatment consisted of 6 cm subclavicular incision extended to the pectoral fascia with 125 mm Hg negative pressure leading to SE regression and vision improvement within 4 h, but reportedly NPWT dressing frequently obstructed, losing suction.…”

“…Treatment consisted of 6 cm subclavicular incision extended to the pectoral fascia with 125 mm Hg negative pressure leading to SE regression and vision improvement within 4 h, but reportedly NPWT dressing frequently obstructed, losing suction. Two days later the dressing was extended to a contralateral side with complete response within the next 24 h [7] . All of the above-mentioned authors agree on safety and efficacy of NPWT use as an alternative and advantageous management of wounds created to relieve poorly controlled SE especially when thoracic surgical intervention is considered contraindicated or too risky.…”

Vacuum-Assisted Closure Therapy as Adjunct to Treatment of Grotesque Subcutaneous Emphysema After Blunt Chest Trauma: A Case Report

“…4). A VAC device was installed, and VAC therapy with the continuous negative pressure of 75 mmHg was initiated as described previously [1,11,12]. SE rapidly improved (Fig.…”