The Probert Encyclopaedia of Medicine

SURGICAL EMPHYSEMA

If air enters the tissues of the body, particularly in the loose cellular tissue immediately under the skin, its presence is detected by a crackling sensation as the skin surface is palpated. This condition is 'surgical emphysema' and it develops most commonly in injuries of the thorax because of the continuous pumping action of the thoracic muscles and diaphragm. A puncture of the skin alone may result in air being drawn in with each movement and being unable to escape. Occasionally this condition is present around fractures (for instance, fractures of the tibia where there has been a puncture wound). Air may escape from a pneumothorax into the tissues surrounding the pleura and this happens particularly with fractures of the ribs. The area of surgical emphysema may spread with alarming rapidity beneath the skin over the chest, extending well up into the neck and down onto the abdominal wall. It is sometimes very painful and its presence makes examination of the thorax or the abdomen very misleading. Surgical emphysema may also be induced by gas-forming organisms - gas gangrene. In thoracic surgery, surgical emphysema is most likely to arise in association with tension pneumothorax.
Research Surgical Emphysema