Definition & Overview
The incision and removal of a foreign body is the surgical procedure of taking out any foreign material stuck in the skin when one is wounded, or the skin is punctured.
Foreign bodies stuck in wounds are usually due to accidents and other trauma to the skin. These foreign bodies are sometimes quite difficult to identify, locate, and remove. Careful consideration of the event leading to the injury and thorough physical examination are needed to confirm the presence of a foreign body. In cases wherein physical examination is not enough to make a confirmation, physicians use imaging technologies, such as X-ray, to get more details. Foreign bodies stuck into the skin due to injury or trauma must be removed as soon as possible to avoid delayed wound healing, further trauma, infection, or even permanent disability.
There are varied types of foreign bodies that could be stuck in flesh wounds. These include splinters of wood, glass fragments, plant thorns, fishhooks, and even pencil lead.
Who Should Undergo and Expected Results
The incision and removal of a foreign body can be recommended to:
Patients with flesh wounds from accidents or trauma, especially those who are experiencing chronic or constant pain that intensifies when pressure is applied to the affected site; this could be an indication that a foreign material is stuck in the wound.
Patients with infected wounds – In such cases, physicians normally consider the possibility of a foreign body stuck in the wound.
Patients whose wound has resulted in physical and functional impairment, since foreign bodies could limit movement or flexibility in the affected body part
Patients with wounds that do not heal. In some cases, patients themselves initiate the process by asking the physician to remove the foreign body, especially if their wound has been neglected for some time.
However, it is good to note that the incision and removal of a foreign body, particularly in subcutaneous tissue, cannot be recommended or performed in certain instances. These include the possibility of injuring nearby nerves or blood vessels, lack of accurate information on the location and depth of the foreign body, potential heavy bleeding, and possible gross deformity.
The procedure is the widely preferred method for taking out any foreign body left inside a wound. With accurate information on the foreign body, its location, and its depth, the procedure has a high success rate and provides immediate relief to patients. Depending on the extent of the injury, the patient is advised to rest for a few days after the procedure. Some may also be asked to undergo physical rehabilitation if the injury has affected their mobility or their ability to perform certain regular tasks. A tetanus shot may also be given after the procedure to help prevent infection.
Some patients may also elect to undergo cosmetic surgery afterwards if the procedure has resulted in an unsightly scar.
How is the Procedure Performed?
Before the actual procedure, the patient is given local anaesthesia to numb the affected part, making the procedure comfortable and painless. Although imaging technology is not used in all cases, the surgeon may require the patient to undergo radiography, ultrasonography, X-ray, or computed tomography (CT scan) to get crucial details about the foreign body particularly its exact location. The information obtained using imaging technology will be used to properly plan the procedure and in choosing the best technique to use to achieve the best possible outcome.
Prior to making an incision, the wound is first explored with a magnification tool and optimal lighting. The surgeon will then decide on the type of incision to make based on the location and size of the involved foreign body.
For deeply embedded foreign bodies, the surgeon will make an elliptical incision around the entry wound and will use a surgical clamp to grasp the skin within the incised area. The surgeon will also make a downward cut around the foreign body before the entire tissue is pulled upward and removed.
The procedure can also be performed using a technique wherein a needle is inserted near the site and guided below the foreign body. The tip of the needle is then made to emerge on the other side of the foreign body while a second needle is inserted across the first needle to propel the foreign body to the surface of the skin. An incision is then made around the entry site where the foreign body is removed.
After removal, the wound is irrigated with saline solution and closed with sutures.
Possible Risks and Complications
Although considered a minor surgical procedure, the incision and removal of a foreign body comes with a number of possible risks and complications. These include:
- Bleeding and infection of the surgical site
- The possibility of enlarging the original wound or accidentally creating additional wounds
- Failure to completely remove the foreign body. Despite careful examination and the use of imaging technology, there are still instances in which parts of the foreign body is retained in the wound. This could make the patient vulnerable to subsequent infection.
- Damage or injury to the surrounding tissue or nearby blood vessels and nerves, which could lead to compromised functioning
Migration of the foreign body to other parts of the body
Levine MR, Gorman SM, Young CF, Courtney DM. Clinical characteristics and management of wound foreign bodies in the ED. Am J Emerg Med. 2008 Oct. 26(8):918-22.
Walters TJ, Wenke JC, Kauvar DS, McManus JG, Holcomb JB, Baer DG. Effectiveness of self-applied tourniquets in human volunteers. Prehosp Emerg Care. 2005 Oct-Dec. 9(4):416-22.