Postoperative subcutaneous emphysema: prevention and treatment

Post-operative subcutaneous (or surgical) emphysema (POSE) affects approximately six percent of patients undergoing thoracic surgery. Pre-operative forced expiratory volume in 1 second (FEV1) and lung diffusion capacity for carbon monoxide (DLCO) poorer than 50% of predicted, the presence of adhesions and a post-operative air leak are predictive factors for post-operative subcutaneous emphysema. POSE leads to increased patient distress, dyspnoea, empyema and prolonged length of stay (LOS). The management of this condition should aim at ensuring that the lung is fully expanded through adequate drainage of the chest cavity, in order to expedite sealing of the parenchymal tear. This may require the use of low-pressure suction (−20 cmH2O) and pleurodesis techniques. Symptomatic relief can be achieved with sub-cutaneous drains or by applying negative pressure dressing [vacuum assisted closure (VAC) pump]. A small percentage of patients (approximately 1%) require a further surgical procedure to control the air leak.