a. General Guidelines.

(1) Take a history of the patient, including information about any unusual medical problems.

(2) Determine the specific characteristics of the foreign body.

(3) Devise the best plan for removing the foreign body. An object such as wood needs to be removed immediately since it can cause inflammation and infection. Objects such as glass or plastic may be removed on an elective basis. Metallic foreign bodies which are causing no additional damage need never be removed.

CAUTION: DO NOT attempt a hasty exploration for the item. Consider other possibilities of injury rather than the patient’s explanation.

(4) Equipment to gather includes a standard suture tray, tissue retractors, and special pick-ups. Remember to have good direct light.

b. Operative Technique. The operative technique to use is tailored to each clinical situation.

CAUTION: DO NOT grab blindly with a hemostat in an effort to remove a foreign object.

(1) Ground-in foreign material or tattooing removal. Use a local anesthetic and meticulous debridement with a sponge, scrub brush, or a tooth brush. Removing of such material or a tattoo may cause permanent disfigurement. It may be impossible to remove all pieces of ground-in foreign matter.

(2) Removal of foreign bodies in fatty tissue. Follow these steps.

(a) Make an elliptical incision surrounding the entrance of the wound.

(b) Grasp the skin of the ellipse loosely with an Allis forceps.

(c) Undercut the incision until the foreign body is contacted.

(d) Remove the foreign body, skin, and entrance tract in one block.

(3) Removal of foreign bodies in the sole of the feet. Assume that foreign matter has been introduced into the wound along with the foreign body. An example of such an occurrence would be a nail going into the foot through a rubber sole of a shoe. You may want to use a magnifying glass to see the foreign body. An ischemic tourniquet is mandatory when you are exploring the foot for a foreign body. Proceed in the following manner.

(a) Enlarge the entrance wound, if necessary, with an adequate incision.

(b) Explore the wound carefully by spreading the soft tissue with a hemostat.

(c) Grasp the foreign body and remove it through the original wound tract.

(d) Irrigate the wound.

(4) Removal of subungual foreign bodies. Removing foreign bodies that are under a nail may require partial or complete removal of the nail. If the nail or the nail bed is to be manipulated, you will need a digital block. Techniques for removing a foreign object from under a nail are given below.

(a) Use a hypodermic needle, bent at the tip. Slide the needle under the nail, hook the object, and withdraw the object.

(b) Use a 19-gauge hypodermic needle to slide under the nail and surround the splinter. Bring the needle tip against the underside of the nail to secure the splinter. Withdraw the needle and splinter as a unit.

(5) Removal of fishhooks. The condition of the fishhook in the body determines the manner used to withdraw the fishhook. Removal techniques are given below.

(a) Infiltrate the area with 1% lidocaine. Force the barb of the fishhook through the anesthetized skin. Clip off the barb and remove the rest of the hook along the direction of entry.

(b) Loop a piece of string or fishing line around the balley of the hook at which the hook enters the skin. Allow about one foot of string for traction. Hold the shank of the fishhook parallel to and in approximation with the skin by the index finger of the left hand. When you have disengaged the barb of the fishhook, pull sharply on the string to remove the hook through the wound entry.

(c) After adequate anesthetic, use an 18-gauge needle to cover the barb. Pass the needle through the wound entrance parallel to the shank of the fishhook. Sheath the barb and allow the fishhook to be backed out.