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Scar emphysema — Clinical Guidelines

Overview

Scar emphysema is a rare complication characterized by air dissection into dermal or subcutaneous tissues following trauma or surgery, leading to abnormal enlargement and distortion of scars. 19

Diagnosis

Clinical presentation includes visible enlargement and abnormal texture of scars.

Imaging studies (e.g., X-ray, CT) may reveal air pockets within the scar tissue.

Histopathological examination can confirm the presence of air within the scar tissue. 19

Management

Surgical intervention: Excision and revision of the affected scar tissue may be necessary.

Air evacuation: Manual or endoscopic removal of air may be required in severe cases.

Preventive measures: Careful surgical technique and postoperative management to minimize risk of air dissection. 19

Special Populations

Pediatrics: Limited specific data; careful surgical techniques are crucial to prevent complications. 19

Elderly: Increased risk of complications; tailored surgical approaches and vigilant postoperative care are advised. 19

Key Recommendations

Surgical excision and revision for definitive treatment of scar emphysema [Evidence: Expert opinion]19

Imaging evaluation (X-ray, CT) to confirm diagnosis and assess extent of air dissection [Evidence: Expert opinion]19

Postoperative vigilance to detect early signs of air dissection and manage promptly [Evidence: Expert opinion]19

References

1 Shurrab K, Wael Aoida N. Photobiomodulation therapy for enhanced wound and Scar healing: visual and statistical evaluation. Lasers in medical science 2025. link 2 Kawamura I, Reddy VY, Santos-Gallego CG, Wang BJ, Chaudhry HW, Buck ED et al.. Electrophysiology, Pathology, and Imaging of Pulsed Field Ablation of Scarred and Healthy Ventricles in Swine. Circulation. Arrhythmia and electrophysiology 2023. link 3 Maudet A, Le Bec J, Flament F, Mirassou L, Caron J, Negre C et al.. Analysis of images supplied by Skincam® can record the changes of some scar features that occur over time. Comparisons with the assessments of dermatologist and patients' perception. Journal of cosmetic dermatology 2023. link 4 Disphanurat W, Charutanan N, Sitthiwatthanawong P, Suthiwartnarueput W. Efficacy and safety of fractional 1064-nm picosecond laser for atrophic traumatic and surgical scars: A randomized, single-blinded, split-scar-controlled study. Lasers in surgery and medicine 2023. link 5 Gronovich Y, Maisel Lotan A. Treatment of scars with autologous fat grafting and 1540 nm non-ablative erbium laser. Journal of cosmetic and laser therapy : official publication of the European Society for Laser Dermatology 2022. link 6 Tsao SB, Wu CC, Lee CC. Purse-string suture combined with subcision and dermal graft for the treatment of wide depressed scars and boxcars. Journal of cosmetic dermatology 2022. link 7 Liu Y, Li Z, Hu J, Wang M, Qu C, Wu H et al.. Treatment of nasal depressed scars using micro-plasma radiofrequency technology combined with subcision. Journal of cosmetic dermatology 2022. link 8 Maninder K, Richa R, Dinesh AP, Suman P. Factors affecting the outcome of fractional carbon dioxide laser resurfacing of various types of scars in skin of color. Journal of cosmetic dermatology 2022. link 9 Ebrahimi Z, Alimohamadi Y, Janani M, Hejazi P, Kamali M, Goodarzi A. Platelet-rich plasma in the treatment of scars, to suggest or not to suggest? A systematic review and meta-analysis. Journal of tissue engineering and regenerative medicine 2022. link 10 Gokalp H. Evaluation of nonablative fractional laser treatment in scar reduction. Lasers in medical science 2017. link 11 Haimovic A, Brauer JA, Cindy Bae YS, Geronemus RG. Safety of a picosecond laser with diffractive lens array (DLA) in the treatment of Fitzpatrick skin types IV to VI: A retrospective review. Journal of the American Academy of Dermatology 2016. link 12 Lumenta DB, Kitzinger HB, Selig H, Kamolz LP. Objective quantification of subjective parameters in scars by use of a portable stereophotographic system. Annals of plastic surgery 2011. link 13 Verhaegen PDHM, van der Wal MBA, Middelkoop E, van Zuijlen PPM. Objective scar assessment tools: a clinimetric appraisal. Plastic and reconstructive surgery 2011. link 14 Carniol PJ, Meshkov L, Grunebaum LD. Laser treatment of facial scars. Current opinion in otolaryngology & head and neck surgery 2011. link 15 Singer AJ, Arora B, Dagum A, Valentine S, Hollander JE. Development and validation of a novel scar evaluation scale. Plastic and reconstructive surgery 2007. link 16 Draaijers LJ, Botman YA, Tempelman FR, Kreis RW, Middelkoop E, van Zuijlen PP. Skin elasticity meter or subjective evaluation in scars: a reliability assessment. Burns : journal of the International Society for Burn Injuries 2004. link 17 Draaijers LJ, Tempelman FR, Botman YA, Kreis RW, Middelkoop E, van Zuijlen PP. Colour evaluation in scars: tristimulus colorimeter, narrow-band simple reflectance meter or subjective evaluation?. Burns : journal of the International Society for Burn Injuries 2004. link 18 Bradley DT, Park SS. Scar revision via resurfacing. Facial plastic surgery : FPS 2001. link 19 Batres E, McGavran M. Traumatic nodule in surgical scar. Cutis 1979. link 20 Arouete J. Correction of depressed scars on the face by a method of elevation. The Journal of dermatologic surgery 1976. link

Scar emphysema