Subcutaneous Emphysema Scholarly Journal
Subcutaneous emphysema is that the de novo generation or infiltration of air within the subcutaneous layer of skin. Skin consists of the epidermis and dermis, with the subcutaneous tissue being beneath the dermis. Air expansion can involve subcutaneous and deep tissues, with the non-extensive subcutaneous spread being less concerning for clinical deterioration. However, the event of subcutaneous emphysema may indicate that air is occupying another deeper area within the body not visible to the unaided eye. Air extravasation in other body cavities and spaces can cause pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum, and pneumothorax. The air travels from these areas along pressure gradients between intra-alveolar and perivascular interstitium, spreading to the head, neck, chest, and abdomen by connecting fascial and anatomic planes. Air will preferentially accumulate in subcutaneous areas with the smallest amount amount of tension until the pressure increases enough to dissect along other planes, causing extensive subcutaneous spread which may result in respiratory and
cardiovascular collapse. Subcutaneous emphysema can result from surgical, traumatic, infectious, or spontaneous etiologies. Injury to the thoracic cavity, sinus cavities, facial bones, barotrauma, bowel perforation or pulmonary blebs are some common causes. Iatrogenic causes may occur thanks to malfunction or disruption of the ventilator circuit, inappropriate closure of the pop-off valve, Valsalva maneuvers that increase thoracic pressure, and
trauma to the airway.
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