Kamata Toshiko, Yoshida Shigetoshi, Hirai Yuki, Karita Ryo, Onozato Yuki, Wada Hironobu, Anayama Takashi
Department of Thoracic Surgery, School of Medicine, International University of Health and Welfare, Narita, Chiba, Japan.
Department of Thoracic Surgery, International University of Health and Welfare, Atami Hospital, Atami, Shizuoka, Japan.
Ann Thorac Cardiovasc Surg. 2025;31(1). doi: 10.5761/atcs.cr.25-00034.
Severe subcutaneous emphysema that is refractory to chest tube drainage can result in significant patient discomfort, airway compromise, and hemodynamic instability. Various interventional approaches, including subcutaneous drain insertion and the blowhole technique, with or without negative pressure wound therapy (NPWT), have been proposed to manage this condition. In this case series, we describe 10 patients who developed severe subcutaneous emphysema following surgery or pneumothorax and were treated using the blowhole technique, with or without NPWT. A Wound Protector/Retractor XXS or LapProtector was used to maintain the patency of the blowhole, facilitating continuous decompression. In cases with more extensive emphysema, the application of NPWT led to rapid respiratory improvement, thereby enabling additional invasive interventions to address the underlying pulmonary air leak. These findings highlight the potential utility of a structured approach incorporating NPWT for the management of severe subcutaneous emphysema, particularly in cases refractory to conventional chest tube drainage.
对胸腔闭式引流难治的严重皮下气肿可导致患者明显不适、气道受压和血流动力学不稳定。已提出各种介入方法，包括皮下置管引流和“气孔技术”，无论是否采用负压伤口治疗（NPWT），来处理这种情况。在本病例系列中，我们描述了10例术后或气胸后发生严重皮下气肿并采用“气孔技术”治疗（无论是否使用NPWT）的患者。使用伤口保护器/牵开器XXS或腹腔镜保护器来保持气孔通畅，促进持续减压。在气肿范围更广的病例中，应用NPWT可使呼吸迅速改善，从而能够采取额外的有创干预措施来解决潜在的肺漏气问题。这些发现凸显了采用包含NPWT的结构化方法处理严重皮下气肿的潜在效用，尤其是在对传统胸腔闭式引流难治的病例中。
