From the Guidelines
Patients develop subcutaneous emphysema after lung cancer surgery and chest tube removal due to air leakage from the lung into surrounding tissues, which can be attributed to incomplete healing of lung tissue, premature chest tube removal, or technical issues with the surgical closure, as supported by the most recent guidelines on enhanced recovery after pulmonary lobectomy 1. This occurs when air escapes from damaged lung tissue or surgical sites and becomes trapped under the skin. After lung cancer surgery, the pleural space may contain air that normally escapes through chest tubes. When these tubes are removed, any persistent air leak can cause air to track along tissue planes, creating the characteristic crackling sensation under the skin. Some key points to consider include:
- Common causes of subcutaneous emphysema in this context include incomplete healing of lung tissue, premature chest tube removal, or technical issues with the surgical closure.
- Risk factors include emphysema, extensive lung resection, and prolonged air leaks during hospitalization, as highlighted in the guidelines on enhanced recovery after pulmonary lobectomy 1.
- The use of digital chest drainage systems for postoperative suction drainage may help reduce chest drainage time and decrease the length of stay, as recommended in the guidelines 1. Most cases resolve spontaneously with conservative management, though severe cases may require needle aspiration or chest tube reinsertion. Supplemental oxygen can help by creating a pressure gradient that encourages air reabsorption, as noted in the management of spontaneous pneumothorax 1. Patients should be monitored for respiratory distress, as extensive emphysema can occasionally compress the airway or impair breathing mechanics. It is essential to follow the most recent guidelines and recommendations to minimize the risk of subcutaneous emphysema and ensure optimal patient outcomes, as emphasized in the guidelines on enhanced recovery after pulmonary lobectomy 1.
From the Research
Causes of Subcutaneous Emphysema
- Subcutaneous emphysema is the inadvertent introduction of air into tissues under the skin covering the chest wall or neck 2.
- Common causes of subcutaneous emphysema include rib fracture, parenchymal lung wound, and esophageal trauma 2.
- It can also occur after pulmonary resection, especially in patients with preoperative forced expiratory volume of air in 1 second (FEV(1)%) less than 50%, those who have an air leak, and those who have had a previous thoracotomy 3.
Development of Subcutaneous Emphysema after Lung Cancer Surgery
- Patients who undergo pulmonary resection for lung cancer are at risk of developing subcutaneous emphysema, especially if they have a persistent air leak 4, 3.
- The use of digital chest drainage systems can help predict prolonged air leakage after pulmonary resection, which can lead to subcutaneous emphysema 5.
- Chest tube removal can also lead to subcutaneous emphysema, especially if there is a persistent air leak or if the patient has undergone a lobectomy 3, 5.
Risk Factors for Subcutaneous Emphysema
- Preoperative FEV(1)% less than 50% is a predictor of developing subcutaneous emphysema after pulmonary resection 3.
- Having an air leak and having had a previous thoracotomy are also risk factors for developing subcutaneous emphysema 3.
- Patients who undergo lobectomy are more likely to develop recalcitrant subcutaneous emphysema, which can be treated with video-assisted thorascopic surgery with pneumolysis 3.