Surgical Blowhole Incision for Acute Subcutaneous Emphysema: A Novel Approach With Negative-Pressure Wound Therapy

This case report describes a patient who sustained significant subcutaneous emphysema of the chest, neck, and face, along with hemopneumothorax and multiple left-sided rib fractures with an associated flail segment following an all-terrain vehicle accident. The emphysema was treated using negative pressure wound therapy (NPWT) applied through bilateral infraclavicular "blowhole" incisions. This report examines the use of NPWT as a treatment modality for subcutaneous emphysema, assessing its efficacy in reducing the need for invasive interventions and promoting recovery. The patient's clinical presentation, NPWT application technique, and treatment progression were documented. Additionally, a literature review was conducted to contextualize NPWT's role in managing subcutaneous emphysema. The patient exhibited a marked reduction in subcutaneous emphysema within 24 hours of NPWT initiation, with continued improvement confirmed through physical examinations and imaging. By day 13, complete resolution was achieved, and NPWT was discontinued without complications. This case highlights NPWT as a promising, minimally invasive treatment option for subcutaneous emphysema, demonstrating rapid resolution and favorable outcomes. Further studies may help define its broader clinical applications.