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Case report: treatment of severe subcutaneous emphysema with a negative pressure wound therapy dressing.

Sciortino CM, Mundinger GS, Kuwayama DP, Yang SC, Sussman MS - Eplasty (2009)

Bottom Line: This article describes a patient who developed severe subcutaneous emphysema and a persistent air leak after several attempts at needle thoracostomy for what was thought to be a tension pneumothorax.A case report of the clinical course and technique was drafted, and the relevant literature in PubMed was reviewed.This technique may be efficacious in other cases of subcutaneous emphysema.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA. csciort2@jhmi.edu

ABSTRACT

Objective: This article describes a patient who developed severe subcutaneous emphysema and a persistent air leak after several attempts at needle thoracostomy for what was thought to be a tension pneumothorax. Subcutaneous emphysema was effectively treated with a topical negative pressure wound therapy dressing applied to a typical subfacial "blowhole" incision. This article aims to describe and contextualize the use of negative pressure wound therapy within the existing treatment options for subcutaneous emphysema.

Methods: A case report of the clinical course and technique was drafted, and the relevant literature in PubMed was reviewed.

Results: The level of subcutaneous emphysema decreased significantly within 48 hours of negative pressure wound therapy as confirmed with physical examination and computed tomography scans. Negative pressure wound therapy for subcutaneous emphysema has not been previously described in the literature.

Conclusions: Negative pressure wound therapy applied over subfascial incisions is a novel technique that effectively and rapidly controlled massive subcutaneous emphysema and persistent air leak. This technique may be efficacious in other cases of subcutaneous emphysema.

No MeSH data available.


Related in: MedlinePlus

Portable roentogram demonstrates resolution of subcutaneous emphysema approximately 48 hours following application of topical negative pressure wound therapy dressing (white arrow).
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Figure 4: Portable roentogram demonstrates resolution of subcutaneous emphysema approximately 48 hours following application of topical negative pressure wound therapy dressing (white arrow).

Mentions: No appreciable change in body contour or crepitance was noted over the next 48 hours; however, the patient's severe SE, which had tracked inferiorly into the abdominal subcutaneous tissues, had stabilized (Fig 3b). A topical negative pressure wound therapy (NPWT) dressing (VAC dressing, KCI International, San Antonio, Tex) was inserted into the blowhole incision and set at a continuous suction of 100 mm Hg (Fig 4). Over the subsequent 48 hours. there was near-complete resolution of SE as supported by physical examination and repeat computed tomography scan (Fig 5). Over the ensuing 4 days, the patient stabilized and was ultimately extubated. An air leak persisted but was adequately controlled by the chest tube. The patient underwent definitive right upper lobe bullectomy approximately 3 weeks later to remove bullae ruptured during attempted needle decompression and chest tube placement. He was discharged in good condition on postoperative day number 6 after a right thoracotomy and right upper lobe bullectomy.


Case report: treatment of severe subcutaneous emphysema with a negative pressure wound therapy dressing.

Sciortino CM, Mundinger GS, Kuwayama DP, Yang SC, Sussman MS - Eplasty (2009)

Portable roentogram demonstrates resolution of subcutaneous emphysema approximately 48 hours following application of topical negative pressure wound therapy dressing (white arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2627309&req=5

Figure 4: Portable roentogram demonstrates resolution of subcutaneous emphysema approximately 48 hours following application of topical negative pressure wound therapy dressing (white arrow).
Mentions: No appreciable change in body contour or crepitance was noted over the next 48 hours; however, the patient's severe SE, which had tracked inferiorly into the abdominal subcutaneous tissues, had stabilized (Fig 3b). A topical negative pressure wound therapy (NPWT) dressing (VAC dressing, KCI International, San Antonio, Tex) was inserted into the blowhole incision and set at a continuous suction of 100 mm Hg (Fig 4). Over the subsequent 48 hours. there was near-complete resolution of SE as supported by physical examination and repeat computed tomography scan (Fig 5). Over the ensuing 4 days, the patient stabilized and was ultimately extubated. An air leak persisted but was adequately controlled by the chest tube. The patient underwent definitive right upper lobe bullectomy approximately 3 weeks later to remove bullae ruptured during attempted needle decompression and chest tube placement. He was discharged in good condition on postoperative day number 6 after a right thoracotomy and right upper lobe bullectomy.

Bottom Line: This article describes a patient who developed severe subcutaneous emphysema and a persistent air leak after several attempts at needle thoracostomy for what was thought to be a tension pneumothorax.A case report of the clinical course and technique was drafted, and the relevant literature in PubMed was reviewed.This technique may be efficacious in other cases of subcutaneous emphysema.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA. csciort2@jhmi.edu

ABSTRACT

Objective: This article describes a patient who developed severe subcutaneous emphysema and a persistent air leak after several attempts at needle thoracostomy for what was thought to be a tension pneumothorax. Subcutaneous emphysema was effectively treated with a topical negative pressure wound therapy dressing applied to a typical subfacial "blowhole" incision. This article aims to describe and contextualize the use of negative pressure wound therapy within the existing treatment options for subcutaneous emphysema.

Methods: A case report of the clinical course and technique was drafted, and the relevant literature in PubMed was reviewed.

Results: The level of subcutaneous emphysema decreased significantly within 48 hours of negative pressure wound therapy as confirmed with physical examination and computed tomography scans. Negative pressure wound therapy for subcutaneous emphysema has not been previously described in the literature.

Conclusions: Negative pressure wound therapy applied over subfascial incisions is a novel technique that effectively and rapidly controlled massive subcutaneous emphysema and persistent air leak. This technique may be efficacious in other cases of subcutaneous emphysema.

No MeSH data available.


Related in: MedlinePlus