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Surgical (subcutaneous) emphysema: Causes, treatment, and more – Medical News Today

Surgical emphysema is another term for subcutaneous emphysema. It occurs when air or gas enters the subcutaneous tissue, which is the deepest layer of the skin.

People can develop surgical emphysema from injury and infection. Common signs of surgical emphysema are bloating and a crackling sound when applying pressure to the swelling.

When a doctor treats the cause, surgical emphysema tends to resolve on its own as the body reabsorbs the gas. However, if the gas bubble is pressing against the lungs or airways, a person may need additional oxygen to help them breathe.

Read on to learn more about surgical emphysema.

A person has surgical emphysema when gas becomes trapped in subcutaneous tissue. In some people, the gas stays in one place and is benign. In others, it can spread along connective tissue such as muscles and ligaments.

According to 2013 research, if the air enters the body through the chest, it can travel to the shoulders, neck, and face. When this happens, a person may experience temporary changes to their facial appearance.

Because the gas tends to collect in areas of the body with the least tension, it can accumulate in spaces or cavities that surround the lungs and heart. This can cause life threatening complications.

The main causes of surgical emphysema are puncture injury and infection.

Puncture injury

Puncture injuries to these areas of the body typically cause subcutaneous emphysema:

  • chest cavity
  • sinus cavity
  • bowel

Infection

Clostridial myonecrosis is a type of bacteria that causes gas gangrene. Toxins from the bacteria produce gas that enters deep muscle tissue. Because the gas cannot escape, the tissue swells, eventually forming a visible lump.

In addition to swelling, a person may notice skin color changes, blood blisters, and air-filled sacs known as bullae.

The following traumas can cause surgical emphysema, according to 2014 research:

People can also experience surgical emphysema during an operation or medical procedure. For example, when a doctor is inserting or moving a tube in the body.

Examples of procedures include:

  • gastric tube placement
  • breathing tube placement
  • laparoscopy

The main symptoms of surgical emphysema are bloating, swelling, and a crackling sound when pressing the swelling.

Additional symptoms depend on the cause and location of swelling. For example, if the gas is trapped in the face and has moved to the eye area, a person may develop a swollen eyelid. Alternatively, if the swelling is in the throat, they may not be able to speak as they typically would.

If the gas expands rapidly and fills the space around the lungs and heart, a person will need immediate medical treatment to help prevent pulmonary and cardiac failure.

Before a doctor can confirm surgical emphysema, they will ask questions about a person’s medical history. They will then perform a physical exam in which they gently press the swelling to hear if there is a crackling sound. This sound is one of the classic symptoms of surgical emphysema.

To detect deeper gas bubbles, they may use a stethoscope and ultrasound device. They may also request imaging such as X-rays and CT scans to identify the air or gas.

In mild cases of surgical emphysema, a healthcare professional may observe a person’s symptoms and wait for the swelling to resolve on its own. This can take up to 10 days, depending on the cause.

If a person is experiencing abdominal discomfort, a doctor may suggest they wear a bind or wrap around the abdomen for additional support.

For more serious subcutaneous emphysema in the lung cavity or deep tissue, a doctor may make an incision and insert a drain to relieve the gas and pressure.

The main risk factors for surgical emphysema are related to trauma. These include injuries to the chest, face, and abdomen. Incidents that involve blunt force trauma or a puncture wound are typically the cause of this condition.

Certain medical procedures can also increase a person’s risk of surgical emphysema. These include air injections and any procedure that requires the insertion of a tube.

In mild cases of subcutaneous emphysema, it is possible that the swelling will go down and eventually disappear. A healthcare professional will be able to advise whether this is likely.

If a healthcare professional recommends them, decompression techniques may help speed up recovery in some cases.

Surgical emphysema is not typically a life threatening condition. However, even in a mild form, it is often uncomfortable and troubling. When gas rapidly expands in the body, it can become life threatening. When this complication happens, it is essential that a person receives treatment immediately to help prevent cardiac or pulmonary failure.

When gas enters the subcutaneous tissue layer of the skin, a person has surgical emphysema. This condition is typically mild and will often resolve on its own within 10 days.

A common sign of surgical emphysema is a crackling sound when a person presses or applies pressure to the swelling. However, this is less obvious when the swelling is located deeper in the body.

If the gas is rapidly expanding in the body, a doctor may make a small incision and insert a drain to alleviate pressure on vital organs such as the heart and lungs.

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