Overview of Wound Foreign Body Removal
Foreign bodies in soft tissues occur when an object enters the body due to a blunt force, a scrape, or a penetrating injury. This object could be anything from a splinter to a piece of glass or metal. Symptoms can show up right away or may take some time to appear, and can differ greatly depending on the type and location of the foreign body.
These foreign bodies can be divided into three categories based on what they’re made from: (a) metallic (like a piece of metal), (b) organic (like a splinter or thorn), and (c) inorganic (like a piece of glass).
These incidents are quite common and the foreign bodies can be very different from one another. Some can be taken out right in the emergency room, while others require a more complex procedure in the operating room. Knowing both how to remove these foreign bodies and understanding which situations call for immediate action and which don’t is crucial.
Anatomy and Physiology of Wound Foreign Body Removal
The factors involved can greatly vary based on where and how deep the injury or foreign body is located. But no matter the details, the first step is the same: understand the layout of the area you’ll be treating. This may seem basic, but it’s crucial in foreseeing any potential issues or complications.
The structures involving nerves and blood vessels are especially important because they can get hurt during the incident or accidentally during the medical procedure. It’s equally vital to be mindful of all other structures in the area. If any nearby structures are damaged, these may need to be fixed immediately. This could mean another specialist needs to be present, which is something to think about when planning any medical procedure.
Why do People Need Wound Foreign Body Removal
In simple terms, if someone has something lodged in their body, such as a splinter or a piece of glass, it may need to be removed surgically by a doctor, especially if it’s causing some serious issues. This is especially true if the foreign object is affecting the function of their nerves or blood vessels or causing an infection. Intense ongoing pain, trouble using the affected area, or feeling like there’s something stuck in their body are also strong signs that surgery may be necessary to remove the object.
There are less urgent reasons for removing the foreign object as well. Sometimes, a person might want to have the object removed because they’re not comfortable with it being there, or because it’s causing a visible change in their appearance. Even though these reasons aren’t as critical as the others, doctors still take them seriously when deciding if surgery is the best option.
When a Person Should Avoid Wound Foreign Body Removal
There are some situations where a doctor might decide not to remove a foreign object from a patient’s body. This might be the case if:
- The wound is clean and shows no signs of infection.
- The patient isn’t aware the foreign body is there.
- Trying to find and remove the foreign object could cause more harm than leaving it in place.
However, if a patient becomes aware of the foreign object or starts having problems because of it at a later stage, the doctor might then decide to take it out.
Equipment used for Wound Foreign Body Removal
The necessary tools for a surgery can differ based on the surgeon’s preference. These typically include a scalpel, which can come in different sizes, and an orthopedic kit that contains a range of instruments. Various sized needles may also be helpful for precise positioning during the surgery. An ultrasound machine or image intensifier, which helps produce live images during surgery, is used to identify the foreign object (the material of the foreign body influences this).
Another important part of the procedure is sutures, which are used to stitch up the wound post surgery. Depending on the type of surgery, different types of dressings are also necessary to cover the wound. For surgeries involving smaller foreign objects, surgeons might ask for magnifying glasses to better see the operative field.
Who is needed to perform Wound Foreign Body Removal?
First and foremost, a surgery needs a skilled surgeon who knows how to explore the problem area and safely remove what’s needed. Other medical professionals are also necessary, such as a surgical scrub nurse who prepares the operating room and an un-scrubbed team member who supports during the surgery but doesn’t directly operate on the patient.
If the surgery is not being done with local anesthetic (numbing just one part of your body), you may need an anesthetist. Anesthetists are doctors who specialize in giving general or regional anesthesia. General anesthesia puts you to sleep completely, while regional anesthesia numbs a larger area of your body.
If the surgery is being done in the emergency department, the main surgeon may need to rely on a less experienced surgical colleague for support and help during the procedure.
Preparing for Wound Foreign Body Removal
Antibiotics are not always necessary when treating a clean, uninfected wound. In cases where the wounds might be dirty or contaminated, the hospital’s guidelines or advice from the hospital’s disease experts are followed in using antibiotics. It’s also wise to check the patient’s immunization status, especially against tetanus, and take necessary steps.
Anesthetic, a medicine that numbs the pain, is often used for surface wounds or those on the limbs. If it’s not possible to numb the area, or if the wound needs a thorough clean and check, then a general or regional anesthetic might be needed. This kind of anesthetic can numb a larger part of the body or even make the patient sleep during the procedure.
The position of the patient will depend on the location and type of wound. The main goal is to provide a good view of the wound for the medical team and ensure the comfort of the patient during the procedure.
In some cases, it may be necessary to use a device known as a limb tourniquet, which restricts blood flow to the area. However, trying to remove all the blood from the area isn’t advisable as it could move the foreign object in the wound. Simply lifting the limb should be enough.
How is Wound Foreign Body Removal performed
The first step is to prepare you for the procedure. This involves positioning you in a way that is best for the surgeon to perform the procedure. An antiseptic solution will be applied to the skin to clean the area. If a tourniquet, a device used to control blood flow to the area, is used, your limb will be raised before its use. This helps reduce the chances of the foreign object moving around when blood is drained from the area. If the surgeon plans to use special imaging tools like ultrasound during the procedure, these tools will be set up and sterilized in advance.
Direct method
If the surgeon is able to access the foreign object through the existing wound, they may decide to enlarge the wound for better exposure. It’s important to thoroughly clean any contaminated wounds with a sterile saltwater solution to prevent infection. Sometimes, the foreign object can be found and removed just by looking closely inside the wound. If this is the case and the wound is clean, it can be stitched up with sutures that don’t dissolve. If there’s an infection, the wound needs to be kept open and checked after a set period of time (usually 48 hours) to allow for healing, a process termed as ‘healing by secondary intention’.
Indirect method
If the foreign body has been there for a while and there’s no noticeable wound, figuring out the best approach to remove it can be challenging. The foreign object might have moved from the place it first entered the body, so the original wound site might not be the best place to start. In such cases, using an ultrasound or image intensifier can be valuable. An ultrasound can be used to make the initial incision, while the image intensifier can be used to give the surgeon a better sense of the foreign object’s position. The surgeon might use an artery clip to grasp the foreign object in two views (front and side), close the clip, and then remove the object.
In some cases, a newer technique may be used where the foreign body is extracted using a vacuum created with a syringe.
Possible Complications of Wound Foreign Body Removal
One concern after surgery is damage to your nerves or blood vessels, which could happen either during the surgery or as a result of the original injury. The severity of this damage will determine if you need more treatment.
Like all surgeries, there’s also a chance of infection. This risk especially increases if the surgery involves a foreign object or if the injury is a puncture wound. Even though doctors thoroughly clean the area during surgery, an infection can still develop. In that case, you might need antibiotics or another operation to clean out the infected area. There’s a specific type of infection, called osteomyelitis, which can occur if a foreign object is left behind.
Sadly, some foreign objects are very tiny and hard to locate during surgery, even with magnifying tools. Another complication can occur if a foreign object is not completely removed during surgery. In some cases, if searching for the object would cause more harm, the doctors might decide to leave it there. This is usually safe and the situation can often be managed carefully.
Keep in mind, you should be informed of all these potential complications either at the time of injury or before surgery. This allows you to provide informed consent, acknowledging you understand the risks and agree to the procedure.
What Else Should I Know About Wound Foreign Body Removal?
Although metal objects such as needles or pieces of jewelry can be easily seen on normal X-rays since they are denser than body tissues, this is not the case for foreign bodies of organic origin like wood splinters or thorns. Non-living things like glass, plastic, or rubber (classified as inorganic) can also be present in the body. However, not all of these materials can be seen clearly using X-rays.
If a doctor suspects there might be a wooden splinter or thorn lodged in a wound, they may need to conduct a more thorough examination of the wound. In these situations, it’s important for patients to closely monitor the area and immediately report any signs of infection or continued presence of a foreign body.
In fact, ultrasound – a method that uses sound waves to create images of the inside of the body – may provide a helpful way to spot these organic intruders, either before surgery or during it. If found beforehand, these objects can even be marked to help guide their removal. This technique can be particularly helpful when it comes to older foreign bodies in cases where the original wound is no longer there.
Inorganic objects like glass or plastic might be visible on an X-ray or ultrasound, but their ease of detection can vary. For instance, glass can usually be found with the help of a simple X-ray. For foreign bodies that are buried deeper within the body or are surrounding certain important body structures, computed tomography (CT scan, a comprehensive type of “X-ray” that gets detailed images of your body) may be necessary to see them better.
If there are signs of infection or if dirty objects were introduced to the body, a thorough clean out (lavage) of the affected wound should be performed in the operating room.
Ideally, any foreign body should be taken out within the first day following an injury. This allows the doctors to best see the point of entry and end of the wound and helps to reduce any inflammation or scarring that may occur afterward.