title: Modified blowhole skin incision using negative pressure wound therapy in the treatment of ventilator-related severe subcutaneous emphysema.
abstract: OBJECTIVE
  A 2-3-cm blowhole incision in the supraclavicular or infraclavicular area is widely used to eliminate the presence of subcutaneous air in cases of life-threatening subcutaneous emphysema (SE). However, when the patient is supported by mechanical ventilation, it is difficult to eliminate completely such air because mechanical ventilation leads consistently to the formation of large amounts of air. To overcome this, we applied negative pressure wound therapy (NPWT) along with blowhole incisions for the treatment of severe SE.
  
  
  METHODS
  To evaluate the feasibility of NPWT, we retrospectively analysed the clinical outcomes of 10 patients who developed severe SE during ventilator care and were treated with a modified blowhole incision using NPWT from January 2009 to November 2013.
  
  
  RESULTS
  All patients showed immediate improvement in SE after NPWT, and no symptom aggravation occurred after NPWT. The mean duration of NPWT was 7.5 ± 5.1 (range, 3-14) days, and the mean number of dressing changes was 1.5 ± 0.7 (range, 1-2). There were no blowhole-incision-related wound infections or any other complications.
  
  
  CONCLUSIONS
  While it is not necessary to apply a blowhole incision with NPWT in all cases of SE, this therapy can be helpful for patients with severe SE associated with mechanical ventilation requiring rapid decompression.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Yangsan, South Korea.
authors.forename: Bong Soo
authors.initials: BS
authors.lastname: Son
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, South Korea.
authors.forename: Sungsoo
authors.initials: S
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, South Korea.
authors.forename: Woo Hyun
authors.initials: WH
authors.lastname: Cho
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Eulji University Hospital, Daejeon, South Korea.
authors.forename: Jung Joo
authors.initials: JJ
authors.lastname: Hwang
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Eulji University Hospital, Daejeon, South Korea.
authors.forename: Kil Dong
authors.initials: KD
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Yangsan, South Korea yumccs@nate.com.
authors.forename: Do Hyung
authors.initials: DH
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019299:Decompression, Surgical / Q000009:adverse effects / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000009:adverse effects; D012121:Respiration, Artificial / Q000009:adverse effects* / Q000295:instrumentation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013352:Subcutaneous Emphysema / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D012122:Ventilators, Mechanical / Q000009:adverse effects*
keywords: Mechanical ventilation; Negative pressure wound therapy; Subcutaneous emphysema