Surgical emphysema is one of a few ways a person can suffer from subcutaneous emphysema, which is marked by pain in the neck and chest associated with air bubbles being trapped in the body's tissues. Also known as crepitus or tissue emphysema, this condition is often observed but not treated, since the bubbles usually dissipate over the course of several weeks. In other cases, further surgical procedures may be needed to disperse the air from the tissue and avoid serious medical damage.
Along with traumatic injuries like gunshots and stabbings, numerous surgical procedures involving the body's respiratory system, particularly the lungs, could lead to subcutaneous emphysema. A faulty chest tube could cause it, as could a fermenting infection like gangrene. Dental surgery is another common cause. Pain is often accompanied with crepitus, which is a pronounced popping sound that intensifies when touched or when the area around it is manipulated.
Depending on the location and severity of the surgical emphysema as well as the nature of the surgery already performed a physician may decide to wait and see what happens. The bubbles are often considered harmless, especially when only faintly present. A doctor may schedule regular visits to watch the location and ensure that the condition does not worsen.
Surgical drainage and decompression of the site is necessary, however, when what is called "massive subcutaneous emphysema" occurs. This can lead to temporary blindness, skin necrosis, extreme pain with breathing, and even death, especially if occurring around the trachea. This drainage can be accomplished by a catheter or even by making an incision to create a hole through which the trapped gas can escape, often with the aid of a vacuum device to spur the process.
If not already present, a chest tube may be used if the surgical emphysema followed a pneumothorax, or collapsed lung, procedure. Another common treatment recommendation involving surgical emphysema includes oxygen supplementation. Rest and pain management through a variety of prescription drugs also could be part of the recovery plan.
The first recorded cases of surgical or subcutaneous emphysema involve dental procedures in the mid- to late-19th century. As surgical procedures evolved and spread into the chest, so too did the cases of surgical emphysema. The phenomenon is technically referred to as pneumomediastinum, which is when air leaks into the chest cavity from the lungs, the neck or face from airways, or even into other areas of the body from the bowels.