van der Molen A B, Birndorf M, Dzwierzynski W W, Sanger J R
Department of Plastic and Reconstructive Surgery, University Hospital, Rotterdam, The Netherlands.
J Hand Surg Am. 1999 May;24(3):638-41. doi: 10.1053/jhsu.1999.0638.
Subcutaneous emphysema of the hand can be benign and noninfectious in origin. Emphysema from gas-forming organisms is associated with systemic symptoms, whereas benign subcutaneous emphysema is not. High-pressure pneumatic tool injuries are a well-known cause of subcutaneous emphysema. Minor wounds in the web space skin may result in a transport of air across the defect, acting like a ball valve mechanism to trap and then force the air into the subcutaneous tissue, as illustrated by 1 of our patients. In the second patient, use of a high-vibration tool without apparent breach of skin was associated with extensive subcutaneous emphysema. The benign nature of the emphysema was revealed by a lack of local pain and inflammation in the presence of extensive crepitus and a lack of systemic symptoms. A noninfectious cause should always be considered. This may prevent unnecessary surgical intervention, which occurred in 1 of the 2 cases presented here.
手部皮下气肿可能起源于良性且无感染性。产气微生物引起的气肿与全身症状相关，而良性皮下气肿则不然。高压气动工具损伤是皮下气肿的一个众所周知的原因。指蹼间隙皮肤的微小伤口可能导致空气穿过缺损处，其作用类似于球阀机制，可捕获空气并将其压入皮下组织，我们的一名患者就出现了这种情况。在第二名患者中，使用高振动工具且皮肤无明显破损却出现了广泛的皮下气肿。气肿的良性性质表现为在存在广泛捻发音的情况下无局部疼痛和炎症，且无全身症状。应始终考虑非感染性原因。这可能避免不必要的手术干预，本文介绍的2例病例中有1例就发生了这种情况。
