From the Guidelines
Subcutaneous gas on X-ray following foreign body removal from the elbow is typically a benign finding that represents air introduced during the procedure rather than infection. No specific treatment is needed if the patient is otherwise well without signs of infection such as increasing pain, redness, warmth, or fever. The air will naturally absorb over several days to weeks. Keep the wound clean and covered with a sterile dressing, changing it as directed by your healthcare provider. Continue any prescribed antibiotics if they were given. Monitor the site for signs of infection including increasing pain, redness, swelling, warmth, pus drainage, red streaking from the wound, or fever. If these symptoms develop, seek prompt medical attention as this could indicate an infection requiring additional treatment. The presence of subcutaneous air alone is expected after procedures that break the skin barrier, as air can enter the tissue spaces during the procedure. This air typically resolves on its own through natural absorption processes without requiring intervention.
Key Considerations
- The presence of subcutaneous gas is not necessarily indicative of a necrotizing infection, as suggested by the study 1, which highlights the importance of clinical judgment in diagnosing soft tissue infections.
- Imaging studies, such as CT or MRI, may be useful in evaluating the extent of disease, but should not delay surgical intervention in cases of suspected necrotizing fasciitis, as recommended by the study 1.
- The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score may be helpful in predicting the presence of necrotizing soft tissue infections, but its sensitivity and specificity are limited, as noted in the study 1.
- Clinical scoring systems, such as the LRINEC score, are more useful for excluding necrotizing soft tissue infections than identifying them, as stated in the study 1.
Recommendations
- Monitor the patient for signs of infection and seek prompt medical attention if symptoms develop.
- Keep the wound clean and covered with a sterile dressing, changing it as directed by your healthcare provider.
- Continue any prescribed antibiotics if they were given.
- Consider imaging studies, such as CT or MRI, to evaluate the extent of disease, but do not delay surgical intervention in cases of suspected necrotizing fasciitis, as recommended by the study 1.
From the Research
Significance of Subcutaneous Gas
The presence of subcutaneous gas visible on X-ray following the removal of a foreign body from the elbow can be a significant finding. This condition is known as subcutaneous emphysema, which can be caused by various factors, including:
- Introduction of air into the soft tissues during the removal of the foreign body 2
- Infection with gas-producing bacteria, such as in the case of gas gangrene 3, 4 The presence of subcutaneous gas can be a concern for gas gangrene, which is a serious and potentially life-threatening condition. However, it is essential to differentiate between non-bacterial and bacterial causes of soft-tissue gas formation to initiate the appropriate treatment 2.
Diagnostic Considerations
The diagnosis of subcutaneous emphysema can be made using radiographs, which can show visible gas in the soft tissues. Other diagnostic techniques, such as computed tomography (CT) scans or ultrasonography, may also be used to evaluate the extent of the gas and to rule out other potential causes 5, 6. In some cases, the presence of subcutaneous gas may not be immediately apparent, and a high index of suspicion is necessary to make the diagnosis. A thorough history and physical examination, as well as radiological evaluations, are crucial in achieving the best outcome in patients with foreign body injuries 6.
Management
The management of subcutaneous emphysema depends on the underlying cause. In cases where the gas is introduced during the removal of a foreign body, the condition may resolve on its own without the need for surgical intervention 2. However, in cases where there is a suspicion of infection, such as gas gangrene, prompt surgical intervention and antibiotic therapy may be necessary to prevent serious complications 3, 4. It is essential to have a low threshold for rapid referral to an appropriate surgical specialty, allowing for prompt and radical surgical management of subcutaneous emphysema, even in the presence of a well patient 4.