Does it feel like your skin is full of air? Let's learn about Subcutaneous Emphysema!

Have you ever noticed that sometimes, after an operation or a minor injury, some people's skin feels like a small bubble when you touch it? Or when you press on certain areas with your hand, you hear a strange sound like a 'kitty kitty'? That's what we're going to talk about today. Although this is a bit new to hear, it's worth knowing.

What is this air filling under the skin? (Subcutaneous Emphysema)

Simply put, `(Subcutaneous Emphysema)` is when air gets trapped in the deepest layer of our skin, the `(subcutaneous)` layer under the skin. This is actually a rather rare condition. But it can have a number of causes. It can be caused by certain infections, injuries, or minor accidents during surgery.

Now you might be wondering if it's a big deal to have air under your skin all the time. In fact, it's normal for a little air to accumulate under your skin after some surgeries, especially laparoscopic surgery. But most of the time, that accumulated air is absorbed by the body and disappears on its own, without causing any major symptoms. However, in some cases, this condition called ``Subcutaneous Emphysema`` can be a sign of another underlying health problem.

This type of puffiness is most commonly seen on the face, neck, or chest , but it can occur anywhere on the body.

This condition is not very common. It is said to affect a small percentage of the general population, about 2%. According to one study, the average age of those diagnosed with it is about 53 years old, and about 70% of them are men.

What are the symptoms? How do we recognize this?

There are two main symptoms that are seen in this condition:

• Swelling of the skin at the affected area: There may be swelling that looks like a small lump. Sometimes doctors call this `(Edema)`.
• A strange sound when you press the skin: As I mentioned before, when you press the swollen area with your hand, you hear a 'crackling' sound, like a dry leaf being crushed or a bubble wrap being crushed. Doctors call this `(Crepitus)`. This is a very distinctive feature of this condition.

In addition to these two main symptoms, there may be several other symptoms:

• Difficulty breathing
• Difficulty swallowing food (also called ``Dysphagia'')
• Sore throat
• Neck pain
• Bloating, as if full of gas

Why is this happening? What are the reasons?

There are several possible causes of `Subcutaneous Emphysema`. Let's see what they are:

• Barotrauma: Imagine, a scuba diver suddenly experiences a huge change in air pressure, whether it's when going up in an airplane or diving into the depths of the water. It could be due to such sudden pressure changes.
• Pneumothorax: Sometimes, when there is damage to the lungs, air leaks out and collects in the chest cavity. Then, that air puts pressure on the lungs and the lungs start to collapse. That is the condition called Pneumothorax. This is also a major cause of Subcutaneous Emphysema.
• Infections: This condition can also be caused by severe infections, especially some severe bacterial infections, such as necrotizing fasciitis.
• Injuries: It can also be caused by injuries to the chest, face, or sinuses in our head.
• Accidents during medical treatment or surgery: Sometimes, air can accumulate under the skin in this way due to minor accidents, such as a medical device malfunctioning or when a device is inserted into the body (e.g., intubation - the insertion of a tube into the airway for someone who has difficulty breathing).

There are other specific medical conditions that can lead to this condition:

• If the bag-mask ventilation used to provide artificial respiration during CPR is not used properly.
• When a feeding tube is inserted to provide food.
• Gastrointestinal perforations are holes in the digestive system.
• A malfunction in the mechanical ventilation machines.

Very rarely, this condition (Subcutaneous Emphysema) can occur without any apparent cause.

Can this cause other complications?

Yes, in some severe cases, `(Subcutaneous Emphysema)` can cause various complications. Some of them are:

• Collapse of the lung (Pneumothorax) (this can be a cause as well as a complication)
• `Compartment syndrome` (this occurs when pressure in a certain compartment increases and blood flow is obstructed)
• If you have a pacemaker, it may interfere with its functioning.
• Decreased blood supply to the brain.
• Respiratory system problems.
• Tracheal compression (meaning something in our bronchial tubes becomes compressed and blocked).

Important: If this condition (Subcutaneous Emphysema) is caused by an infection, it can lead to very serious, even life-threatening, complications. For example:

* Acute respiratory distress syndrome (ARDS)

*Coma

* Delirium

* Kidney failure

* Tissue death `(Necrosis)`

* Sepsis (a severe infection that spreads throughout the body)

That's why it's said that if you have any doubts, even if it's just a small one, you should see a doctor.

How do doctors detect this?

A doctor will need to perform several tests to determine exactly whether you have ``(Subcutaneous Emphysema)``. Let's look at what those tests are:

• Bronchoscopy: This involves passing a small camera-equipped tube down the trachea to check for any problems with the lungs and airways.
• CT scan (Computed Tomography scan): This is similar to an X-ray, but a computer uses many X-rays to create very clear, detailed images of things inside our bodies, such as bones and tissues.
• Ultrasound scan: This uses high-frequency sound waves to take pictures of the inside of the body.
• X-rays: Use radiation to take two-dimensional pictures of things like our bones and tissues.

The type of test you need will depend on where you have swelling and what your doctor thinks may be causing your symptoms.

What are the treatments for this?

When treating `(Subcutaneous Emphysema)`, the most important thing is to find and treat the underlying cause. Once your doctor starts treating the cause, your symptoms should improve within 10 to 14 days.

Usually, in less severe cases, doctors use oxygen concentrators. These devices allow us to breathe about 95% pure oxygen. This means that our body gets more oxygen, which helps the air trapped under the skin to be reabsorbed more quickly.

Sometimes, the doctor may need to do things like this to remove any extra air that is trapped:

• Chest tube (Thoracostomy)
• Making two small incisions under the clavicle bones on our shoulders.
• Using needles, catheters (small tubes with holes), or small incisions to remove air from other parts of the body.

However, if the condition is very severe, surgery may be necessary. Alternatively, doctors may insert small tubes (drains) to allow excess air to escape.

Is there anything I can do to reduce my discomfort?

Subcutaneous emphysema doesn't always cause painful symptoms. But if you're experiencing any discomfort or pain, your doctor may recommend the following:

• Analgesics
• An abdominal binder (this may help reduce swelling and discomfort)
• Concentrated oxygen (as mentioned earlier, to help with breathing)

How long does it take to heal from this?

Most people recover within 10 to 14 days of treatment. According to one study, the average recovery time, even in severe cases, was about 16 days. So, with proper treatment, you can recover quickly.

What is the outlook for this situation? (Outlook)

With treatment, the outlook is generally good. That means there is a good chance of recovery. But time is of the essence here. The sooner you see a doctor, the sooner you can reduce your symptoms and reduce the risk of serious complications.

How long will this situation last?

With treatment, most people with ``Subcutaneous Emphysema'' recover within about two weeks.

Is there a way to prevent this?

Most of the time, `(Subcutaneous Emphysema)` occurs for reasons beyond our control. That means something like an accident or surgery. So there's really nothing you can do to prevent it from happening. It's not your fault. If you develop any symptoms, the best thing to do is to talk to a doctor right away. The doctor will then decide if you need treatment, and if so, what kind.

When should I see a doctor?

If you experience any of the symptoms below, see a doctor immediately:

• Swelling of the skin without any reason.
• If you hear a 'squeaking' sound when you press on the affected skin.
• Bloating.
• If it is difficult to breathe or swallow something.
• If you have neck pain or a sore throat.

It's not good to delay at a time like this. It's important to get treatment quickly.

What questions should I ask the doctor?

If you are diagnosed with ``Subcutaneous Emphysema'', you may want to ask your doctor questions like:

• What is causing this situation for me?
• Will this heal on its own?
• Do I need treatment? If so, what kind of treatment?
• Will I have to stay in the hospital?
• When will I be able to go back to work or school?

It is very important to ask these questions and gain a clear understanding of your situation.

Is this ``Subcutaneous Emphysema'' an emergency?

Subcutaneous emphysema is not always an emergency or life-threatening condition. However, no matter what your condition, it is important to seek treatment quickly. Most people with this condition have only mild symptoms. However, some people can develop serious complications. If you have any worrying symptoms – for example, your skin looks swollen and puffy, or you hear that 'squeaky' sound – you should see a doctor right away.

Having an injury or undergoing surgery is already stressful. On top of that, if a complication occurs, you may feel like you'll never be able to go back to normal. Subcutaneous emphysema is a rare condition. However, if it occurs, it's important to seek medical attention immediately. If left untreated, subcutaneous emphysema can lead to additional – and possibly more serious – complications.

Final Take-Home Message

Okay, so now you have a better understanding of what we've been talking about, ``(Subcutaneous Emphysema)''. The most important thing is to not panic if you see these symptoms, but to see a doctor without delay.

Remember:

* Although air accumulation under the skin is rare, it can be caused by certain health problems.

* The main symptoms are swelling of the skin and a 'squeaky' sound when touched.

* If you find the cause and treat it, you can recover quickly.

* If in doubt, seek medical advice immediately.

Wishing you and your family good health!

` Subcutaneous Emphysema, air filling of the skin, air under the skin, swelling, crepitus, difficulty breathing, lung problems