Novel management of extensive subcutaneous emphysema in cardiac surgery: cases presentation

Document Type : case report

Authors

Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

Abstract

Subcutaneous emphysema occurs when air is trapped between subcutaneous tissues and manifests as sudden swelling, dysphonia, and sore throat. In many severe cases, subcutaneous emphysema causes dysphagia, pain, and breathing difficulty. The current study reports two cases of successful management of extensive subcutaneous emphysema after cardiac surgery.
The first patient was a 60-year-old man with a history of coronary artery disease who underwent coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass. He was transferred to the intensive care unit (ICU) in good condition. Twelve hours after the surgery, he was extubated in a stable condition. On the second day after the surgery, his face, neck, and chest began to swell due to extensive subcutaneous emphysema, and he experienced decreased SPO2 and severe respiratory distress.
The second patient was a 65-year-old woman with a history of myocardial infarction (MI) who had CABG off-pump surgery. After surgery, the patient was transferred to the ICU in a favorable and stable condition and was extubated 6 hours after the surgery. Her face, neck, and chest started swelling three days after the surgery, and she had severe respiratory distress and decreased blood saturation due to extensive subcutaneous emphysema.
In both cases, despite conventional treatment, the patient's symptoms escalated despite re-intubation and mechanical ventilation.In the operating room, the chest tubes were removed, two new chest tubes were inserted, and the area damaged by the old tubes was repaired. Shortly after the insertion of the chest tubes, the patient's emphysema symptoms decreased significantly.

Keywords

References

1.Lodhia JV, Tenconi S. Postoperative subcutaneous emphysema: prevention and treatment. Shanghai Chest. 2021;5:17.
2.Cerfolio RJ, Bryant AS, Maniscalco LM. Management of subcutaneous emphysema after pulmonary resection. Ann Thorac Surg. 2008;85(5):1759-63.
3.Mihanović J, Bačić I, Sulen N. Negative-pressure in treatment of persistent post-traumatic subcutaneous emphysema with respiratory failure: case report and literature review. Trauma Case Rep. 2017;13:42-45.
4.Singhal S, Ferraris VA, Bridges CR, et al. Management of alveolar air leaks after pulmonary resection. Ann Thorac Surg. 2010;89(4):1327-35.
5.RYDELL JR, JENNINGS WK. Emergency cervical mediastinotomy for massive mediastinal emphysema. AMA Arch Surg. 1955;70(5):647-53.
6.Davies J, Spitzer D, Phylactou M, et al. Cardiac arrest due to a missed diagnosis of Boerhaave's syndrome. BMJ Case Rep. 2016;2016: bcr2014208659.
7.Aghajanzadeh M, Dehnadi A, Ebrahimi H, et al. Classification and management of subcutaneous emphysema: a 10-year experience. Indian J Surg. 2015;77(2):673-7.
8.Tran Q, Mizumoto R, Mehanna D. Management of extensive surgical emphysema with subcutaneous drain: a case report. Int J Surg Case Rep. 2018;44:126-130.
9.Byun CS, Choi JH, Hwang JJ, et al. Vacuum-assisted closure therapy as an alternative treatment of subcutaneous emphysema. Korean J Thorac Cardiovasc Surg. 2013;46(5):383-7.
10.Lloyd MS, Jankowksi S. Treatment of life-threatening surgical emphysema with  liposuction. Plast Reconstr Surg 2009;123(2):77e-78e.
Cardiovascular Biomedicine
Volume 2, Issue 2
December 2022
Pages 31-35

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History

  • Receive Date: 20 April 2022
  • Revise Date: 25 February 2023
  • Accept Date: 04 March 2023
  • First Publish Date: 04 March 2023

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