Subcutaneous drain insertion in patients with post-operative extensive subcutaneous surgical emphysema: a single centre experience

Abstract

Extensive surgical subcutaneous emphysema (ESE) albeit a benign condition could cause patients distress and in many cases temporary vision impairment. We describe the role and value of early subcutaneous drain insertion (SCD) in the management of ESE and patients' experience in this cohort study. Extensive surgical subcutaneous emphysema is that which extends to the neck and/or the peri-orbital region. A cohort study of a prospectively collected data was conducted between December 2009 and January 2012. All patients with extensive post-operative surgical emphysema who had SCD (size ≥24 French gauge) were included. 1069 thoracic procedures were performed. 21 patients (1.96%) were diagnosed with extensive surgical emphysema, there were 16 males, median age was 65 (54-82years). There were 16 VATS and 5 open procedures. All patients had chest surgical emphysema, 16 patients had peri-orbital and neck swelling and 5 had neck swelling. Surgical emphysema occurred within a median of 3days post-operatively. 14 (67%) patients had 1 subcutaneous drain inserted, and 7 (33%) had bilateral SCD insertion (1 drain each side). 19 (90%) patients experienced improvement of their symptoms with resolution of neck and peri-orbital swelling within 1day of SCD insertion, 2 patients had their symptoms improved within 2days. All patients were satisfied with the outcome following insertion of SCD. ESE should always be investigated and treated promptly. Early SCD insertion has a valuable role in the management of ESE with improvement of patients' experience.