Management of post-operative subcutaneous emphysema with the application of wound VAC therapy

Michael J Minarich; Leonard R Henry; Ashley Hardy; Urs von Holzen

doi:10.1093/jscr/rjab103

Management of post-operative subcutaneous emphysema with the application of wound VAC therapy

J Surg Case Rep. 2021 Apr 24;2021(4):rjab103. doi: 10.1093/jscr/rjab103. eCollection 2021 Apr.

Authors

Michael J Minarich^{1

2}, Leonard R Henry^{1

3}, Ashley Hardy^{1

3}, Urs von Holzen^{1

3

4}

Affiliations

¹ Goshen Center for Cancer Care, Goshen, IN 46526, USA.
² Fox Chase Cancer Center, Philadelphia, PA 19111, USA.
³ Indiana University School of Medicine South Bend, South Bend, IN 46617, USA.
⁴ University of Basel, Basel 4031, Switzerland.

Abstract

Extensive subcutaneous emphysema (SE) complicates between 1 and 6% of elective thoracic procedures. The management of SE is varied, and may include increasing the suction of chest tubes, placement of additional chest tubes, placement of subcutaneous drains and creation of releasing incisions. We present five patients with post-operative SE treated successfully with a subcutaneous infraclavicular incision and wound VAC therapy. A 5-cm incision was made 2 cm below the clavicle down and through the pectoralis major fascia. A VAC dressing was fitted to the wound and suction was applied to -125 mm Hg. Data were retrospectively collected and analyzed. VAC dressing was placed a median of 6 days after initial operation. All patients had improvement in symptoms and resolution of SE by VAC dressing therapy. Subcutaneous infraclavicular incision and VAC dressing placement is a viable treatment for patients with post-operative SE who fail conservative therapy.

Keywords: Post-operative management; Post-operative subcutaneous emphysema; Wound VAC placement.

Publication types

Case Reports