Use of Closed Incision Negative Pressure Therapy for Massive Subcutaneous Emphysema

Subcutaneous emphysema is typically due to an air leak through the parietal pleura, allowing air to escape from the lung parenchyma into the adjacent soft tissue. Most cases are benign and self-limiting; however, when enough air is forced into the subcutaneous tissues allowing the air to spread into the neck, tracheal compression and respiratory distress can occur. Tube thoracotomy and endotracheal intubation are generally sufficient to overcome this respiratory compromise. However, occasionally other invasive measures are required to allow the air leak to resolve. Traditionally, this would involve placement of an incision or two into the anterior chest wall to allow decompression to the outside environment. Limited evidence exists regarding negative pressure wound therapy devices being used successfully with open incisions for the management of massive subcutaneous emphysema.  We present the initial case of successful use of a loosely closed incision negative pressure therapy for massive subcutaneous emphysema. In this instance, the patient's thoracic injury was successfully stabilized and use of the negative pressure therapy device allowed the incisions to be closed with a much more cosmetically pleasing result.