# Case Series of Blowhole Creation with or without Negative Pressure Wound Therapy for Severe Subcutaneous Emphysema

## TL;DR

This case series explores using blowhole techniques with or without negative pressure wound therapy to treat severe subcutaneous emphysema when chest tubes fail.

## Contribution

The study introduces a structured approach using blowhole techniques and NPWT for managing severe subcutaneous emphysema.

## Key findings

- Blowhole techniques with NPWT improved respiratory status in patients with severe subcutaneous emphysema.
- NPWT enabled additional invasive interventions by rapidly reducing emphysema.
- The use of Wound Protector/Retractor devices maintained blowhole patency for continuous decompression.

## Abstract

Severe subcutaneous emphysema that is refractory to chest tube drainage can result in significant patient discomfort, airway compromise, and hemodynamic instability. Various interventional approaches, including subcutaneous drain insertion and the blowhole technique, with or without negative pressure wound therapy (NPWT), have been proposed to manage this condition. In this case series, we describe 10 patients who developed severe subcutaneous emphysema following surgery or pneumothorax and were treated using the blowhole technique, with or without NPWT. A Wound Protector/Retractor XXS or LapProtector was used to maintain the patency of the blowhole, facilitating continuous decompression. In cases with more extensive emphysema, the application of NPWT led to rapid respiratory improvement, thereby enabling additional invasive interventions to address the underlying pulmonary air leak. These findings highlight the potential utility of a structured approach incorporating NPWT for the management of severe subcutaneous emphysema, particularly in cases refractory to conventional chest tube drainage.