Removal of foreign body from under the skin
This can sometimes be tricky.
Cases I have seen include:
1. Removing a box thorn embedded deep in the tissues
2. Metallic foreign body – located by the use of a magnet; not always possible to remove it – especially if it is deeply located; sometimes one has to use an image intensifier in theatre, this is often an injury from work-related cause(eg miner in Broken Hill, apprentice on first day at work with mechanic; worker in factory)
3. Deeply penetrating large splinter – part of it was initially removed at a major trauma centre, patient was referred to me weeks later as persisting pain and granuloma. On exploration, 4cm remnant of penetrating splinter found and removed
(It is not always possible to remove every single fragment especially if friable object)
4. Spines of fish – this can be very hard to find, sometimes can be radioopaque
5. Broken glass – again also can be hard to find, I would say it is sometimes harder than looking for a needle in a haystack! But is it often satisfactory to be able to find the broken fragment.
6. Splinters, rose thorns etc
Sometimes by the time I am referred, a small abscess has formed around the foreign body – then it is easier to incise over the abscess, drain the abscess and remove the foreign body.
Reminder for residents:
Check tetanus status
Consider oral antibiotics treatment
Xray can be helpful to the surgeon ?radioopaque – some glasses are