Introduction: Subcutaneous emphysema is a clinical condition, a very common complication of mediastinal emphysema, which can occur as a result of blunt or penetrating trauma, pneumothorax, surgical interventions, or spontaneously. In rare cases, it progresses rapidly and can lead to disruption of normal ventilation and blood supply to the neck and head.
Aim: The aim of this article is to present the experience of the clinic in the treatment of massive subcutaneous emphysema through the application of vacuum therapy.
Materials and Methods: For the period from January 2022–October 2023, in the Clinic of Thoracic Surgery, vacuum therapy was applied in the treatment of 25 patients with pneumothorax and subcutaneous emphysema. Of these, 22 were men and 3 were women, aged 18 to 71 years (average age 58 years). In 8 (32%) of the patients, the subcutaneous emphysema was caused by iatrogenic pneumothorax, in 5 (20%)—by traumatic pneumothorax, in 10 (40%)—by spontaneous pneumothorax, in 1 (4%)—by secondary pneumothorax in verified lung carcinoma, and in 1 (4%)—by secondary pneumothorax in asthma attack. In all, the Renasys Ez Max vacuum dressing device was used.
Results: Vacuum therapy was applied for 1.5 days (0–3 days) on average, after drainage of the pleural cavity in the presence of clinical data for grade V subcutaneous emphysema or a progressing one, not amenable to treatment with a pleural drain. In all patients, a significant reduction of subcutaneous emphysema was clinically observed within the first 24 hours. Complete evacuation of air occurred on the 5th day (4–6 days) on average. The application of vacuum therapy lasted an average of 7 days. The machine was removed after radiographic confirmation of no leakage. No recurrence of subcutaneous emphysema and complications related to vacuum therapy were observed.
Conclusion: Vacuum therapy cannot replace pleural drainage, but its accessibility, ease of application, and rapid effect
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