Fasciotomy: yes or no? A case of benign subcutaneous emphysema

Abstract

A 54-year-old woman presented with a swollen hand 15 hours after a superficial incision between her fingers by a letter opener. She was afebrile and hemodynamically stable, with minimal pain. On examination, there was crepitus from the dorsum of the hand to the forearm, without any inflammatory signs. Radiographs revealed subcutaneous emphysema without fascial involvement, and inflammatory markers were normal. Infectious causes such as necrotizing fasciitis were ruled out; a diagnosis of benign subcutaneous emphysema was retained. Mechanisms likely included a bellows effect, a one-way valve entry, and spread through a locus minoris resistentiae. The patient recovered fully with immobilization and prophylactic antibiotics.