Overview
Surgical emphysema, also known as subcutaneous emphysema, is a medical condition where air becomes trapped under the skin, typically in the subcutaneous tissues. It often occurs after surgery or trauma and is characterized by swelling and a crackling sensation upon touch. While it is usually harmless and resolves on its own, it can be a sign of a more serious underlying issue if extensive or rapidly progressing.
What is Surgical Emphysema?
Surgical emphysema refers to the presence of air in the subcutaneous tissue, most commonly caused by a leak from the respiratory tract, gastrointestinal tract, or after invasive procedures. The air can travel along tissue planes, causing swelling in areas such as the face, neck, or chest. It is often seen after thoracic surgery, chest tube placement, endoscopy, or traumatic injuries.
Symptoms
- Swelling under the skin (face, neck, chest, or arms)
- A crackling or popping sensation when touched (crepitus)
- Mild discomfort or pain
- Skin tightness
- In severe cases: breathing difficulties or voice changes
Causes
- Post-surgical complication (thoracic or neck surgeries)
- Chest trauma (rib fractures, lung injury)
- Pneumothorax (collapsed lung with air leakage)
- Chest tube insertion or removal
- Endoscopic or laparoscopic procedures
- Airway injury (e.g., intubation complications)
Risk Factors
- Thoracic or neck surgeries
- Mechanical ventilation
- Chest trauma
- Pre-existing lung diseases (COPD, asthma)
- High airway pressures during surgery
- Recurrent procedures involving airways or chest
Complications
- Cosmetic facial and neck swelling
- Breathing difficulties if swelling compresses airways
- Progression to tension pneumothorax
- Infection in severe or prolonged cases
- Air tracking to mediastinum (pneumomediastinum)
Prevention
- Careful surgical technique to avoid air leaks
- Proper chest tube management
- Monitoring airway pressures during ventilation
- Prompt treatment of pneumothorax
- Minimizing unnecessary invasive airway procedures
Treatment Options in Korea
In South Korea, treatment of surgical emphysema focuses on identifying and managing the underlying cause. Medical centers such as Seoul National University Hospital, Samsung Medical Center, and Asan Medical Center provide advanced diagnostic and treatment options, including:
- Observation for mild cases, with monitoring until the air is reabsorbed
- Supplemental oxygen therapy to accelerate air absorption
- Chest tube insertion if associated with pneumothorax
- Surgical repair of air leaks in severe or persistent cases
- High-resolution imaging (CT scan) to locate the source of air leakage
- Minimally invasive thoracic surgery (VATS) for complex cases
