A Novel Treatment for Subcutaneous Emphysema (SE) After Cardiac Surgery by PRP-fibrin Glue: A Case Series

Introduction: Subcutaneous emphysema (SE) is a rare but potentially serious complication after cardiothoracic surgery, often caused by persistent pleural air leaks. Standard management, including supportive care and chest tubes, may be slow or insufficient. Platelet-rich plasma fibrin glue (PRP-FG) combines adhesive and regenerative properties and has shown promise in thoracic air leak management. Method: Three patients developed SE following coronary artery bypass grafting or congenital heart defect repair. Each received a single or multiple intrapleural PRP-FG injections (300 mL) via a chest tube after conventional interventions failed. PRP-FG was prepared from banked blood under sterile conditions in the ICU. Results: All patients experienced rapid clinical improvement within 48–72 hours, with complete resolution of SE and no PRP-FG-related complications. Follow-up at three months confirmed sustained resolution. Conclusion: PRP-FG may be a safe and effective adjunct for refractory postoperative SE, providing both mechanical sealing and biological stimulation to accelerate air leak closure. Further studies are needed to confirm efficacy and establish treatment protocols.