title: Subcutaneous tissue emphysema of the hand secondary to noninfectious etiology: a report of two cases.
abstract: Subcutaneous emphysema of the hand can be benign and noninfectious in origin. Emphysema from gas-forming organisms is associated with systemic symptoms, whereas benign subcutaneous emphysema is not. High-pressure pneumatic tool injuries are a well-known cause of subcutaneous emphysema. Minor wounds in the web space skin may result in a transport of air across the defect, acting like a ball valve mechanism to trap and then force the air into the subcutaneous tissue, as illustrated by 1 of our patients. In the second patient, use of a high-vibration tool without apparent breach of skin was associated with extensive subcutaneous emphysema. The benign nature of the emphysema was revealed by a lack of local pain and inflammation in the presence of extensive crepitus and a lack of systemic symptoms. A noninfectious cause should always be considered. This may prevent unnecessary surgical intervention, which occurred in 1 of the 2 cases presented here.
authors.affiliation: Department of Plastic and Reconstructive Surgery, University Hospital, Rotterdam, The Netherlands.
authors.forename: A B
authors.initials: AB
authors.lastname: van der Molen
authors.forename: M
authors.initials: M
authors.lastname: Birndorf
authors.forename: W W
authors.initials: WW
authors.lastname: Dzwierzynski
authors.forename: J R
authors.initials: JR
authors.lastname: Sanger
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D006225:Hand; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D013352:Subcutaneous Emphysema / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy
chemical_list: D000900:Anti-Bacterial Agents