Benign subcutaneous emphysema

The rarely described benign subcutaneous emphysema can occur in different regions of the body. Air entrapment close to a joint is frequently in the extremities. Accidents involving pneumatic devices have also been reported as a cause. With respect to treatment, life-threatening emphysema of infectious origin must be ruled out but is not always possible with certainty, particularly in the early stage. During the initial treatment in the emergency room, in addition to the clinical picture the laboratory risk indicator for necrotizing fasciitis (LRINEC) score is also available. If there are doubts about the benign nature of the emphysema, a surgeon with experience in soft tissue infections must be consulted at an early stage. The timely certain exclusion of a potentially life-threatening gas-forming soft tissue infection, such as necrotizing fasciitis, can sometimes only be achieved through surgical exploration, which can be avoided with an adequate diagnosis in the emergency room

Dupuytren's Disease–Etiology and Treatment

BACKGROUND: The worldwide prevalence of Dupuytren’s disease (DD) is 8%. DD is a chronic disease for which there is no cure. Various treatments are available. METHODS: This review is based on pertinent publications retrieved by a selective search in PubMed and Embase. RESULTS: Genetic factors account for 80% of the factors involved in causing this disease. Diabetes mellitus, hepatic diseases, epilepsy, and chronic occupational use of vibrating tools are also associated with it. Limited fasciectomy is the most common treatment and is considered the reference standard. Possible complications include persistent numbness in areas where the skin has been elevated, cold sensitivity, and stiffness, with a cumulative risk of 3.6 –39.1% for all complications taken together. The recurrence rate at 5 years is 12–73%. Percutaneous needle fasciotomy is the least invasive method, with more rapid recovery and a lower complication rate than with limited fasciectomy. 85% of patients have a recurrence after an average of 2.3 years. Radiotherapy can be given before contractures arise in patients with high familial risk, or postoperatively in selected patients with a very high individual risk of recurrence. CONCLUSION: Although DD is not curable, good treatments are available. Recurrences reflect the pathophysiology of the disease and should not be considered complications of treatment. When counseling patients about the available treatment options, particularly the modalities and timing of surgery, the physician must take the patient’s degree of suffering into account. Nowadays, fast recovery from surgery and less postoperative pain are a priority for many patients. Different surgical methods can be used in combination. It remains difficult to predict the natural course and the time to postoperative recurrence in individual patients; these matters should be addressed in future studies