Bong Soo Son1, Sungsoo Lee2, Woo Hyun Cho3, Jung Joo Hwang4, Kil Dong Kim4, Do Hyung Kim5. 1. Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Yangsan, South Korea. 2. Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, South Korea. 3. Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, South Korea. 4. Department of Thoracic and Cardiovascular Surgery, Eulji University Hospital, Daejeon, South Korea. 5. Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Yangsan, South Korea yumccs@nate.com.
Abstract
OBJECTIVES: A 2-3-cm blowhole incision in the supraclavicular or infraclavicular area is widely used to eliminate the presence of subcutaneous air in cases of life-threatening subcutaneous emphysema (SE). However, when the patient is supported by mechanical ventilation, it is difficult to eliminate completely such air because mechanical ventilation leads consistently to the formation of large amounts of air. To overcome this, we applied negative pressure wound therapy (NPWT) along with blowhole incisions for the treatment of severe SE. METHODS: To evaluate the feasibility of NPWT, we retrospectively analysed the clinical outcomes of 10 patients who developed severe SE during ventilator care and were treated with a modified blowhole incision using NPWT from January 2009 to November 2013. RESULTS: All patients showed immediate improvement in SE after NPWT, and no symptom aggravation occurred after NPWT. The mean duration of NPWT was 7.5 ± 5.1 (range, 3-14) days, and the mean number of dressing changes was 1.5 ± 0.7 (range, 1-2). There were no blowhole-incision-related wound infections or any other complications. CONCLUSIONS: While it is not necessary to apply a blowhole incision with NPWT in all cases of SE, this therapy can be helpful for patients with severe SE associated with mechanical ventilation requiring rapid decompression.
OBJECTIVES: A 2-3-cm blowhole incision in the supraclavicular or infraclavicular area is widely used to eliminate the presence of subcutaneous air in cases of life-threatening subcutaneous emphysema (SE). However, when the patient is supported by mechanical ventilation, it is difficult to eliminate completely such air because mechanical ventilation leads consistently to the formation of large amounts of air. To overcome this, we applied negative pressure wound therapy (NPWT) along with blowhole incisions for the treatment of severe SE. METHODS: To evaluate the feasibility of NPWT, we retrospectively analysed the clinical outcomes of 10 patients who developed severe SE during ventilator care and were treated with a modified blowhole incision using NPWT from January 2009 to November 2013. RESULTS: All patients showed immediate improvement in SE after NPWT, and no symptom aggravation occurred after NPWT. The mean duration of NPWT was 7.5 ± 5.1 (range, 3-14) days, and the mean number of dressing changes was 1.5 ± 0.7 (range, 1-2). There were no blowhole-incision-related wound infections or any other complications. CONCLUSIONS: While it is not necessary to apply a blowhole incision with NPWT in all cases of SE, this therapy can be helpful for patients with severe SE associated with mechanical ventilation requiring rapid decompression.
Authors: Nicky Janssen; Iris E W G Laven; Jean H T Daemen; Karel W E Hulsewé; Yvonne L J Vissers; Erik R de Loos Journal: J Thorac Dis Date: 2022-01 Impact factor: 2.895
Authors: Rahul V Nene; Adam T Hryniewicki; Elizabeth Roderick; Scott Chicotka; Moises Hernandez Vazquez; Patricia A Thistlewaite; Christanne Coffey; Mazen F Odish Journal: Am J Emerg Med Date: 2021-09-04 Impact factor: 2.469