eMedicine Specialties > Clinical Procedures > Soft Tissue Procedures

Foreign Body Removal, Wound

Robert Edward Mittendorff II, MD, MBA,
Erik D Schraga, MD, Consulting Staff, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates; Consulting Staff, Permanente Medical Group, Kaiser Permanente, Santa Clara Medical Center

Updated: Aug 26, 2008

Introduction

Soft tissue foreign bodies are frequently a result of penetrating or abrasive trauma and can result in substantial patient discomfort, deformity, complications involving localized and systemic infection, and further trauma during removal. For information on trauma of all kinds, visit Medscape's Trauma Resource Center.

In most cases, foreign bodies are the result of accidental trauma directly to the soft tissue area of interest; however, other mechanisms such as unwitnessed syncope, potential elder or child abuse, or assault by other persons or personal harm should also be considered.^1,2 Patients who present with localized pain after trauma should be questioned about the specific nature of the trauma and examined for an obvious or occult foreign body. Straightforward cases that involve solid, formed, metallic objects obvious on examination, such as nails, staples, and needles, may require less history than the case of an individual with localized pain and foreign body sensation who is unaware of the exact time of onset, sequence of events leading to symptoms, or potential foreign bodies.³

3-mm hole in patient forearm (entrance).

Soft tissue infection caused by foreign bodies can result in additional emergency department (ED) and primary care visits; this is a frequent reason for physician malpractice litigation. Wound care is the subject of 5-20% of lawsuit claims against emergency physicians, and claims about wound care result in 3-11% of award payouts.¹⁵ For more information on wound care, visit Medscape's Wound Management Resource Center. For information on malpractice litigation, visit Medscape's Medical Malpractice and Legal Issues Resource Center.

Indications

Indications for removal of a foreign body include the following:¹⁴

• Neurovascular compromise
• Evidence of infection
• Cosmetic deformity
• Functional impairment
• Chronic pain
• Patient request

The potential for complications due to the process of removal must be considered. Such complications may include the following:⁷

• Enlarging the wound or creating an additional wound
• Blunt or sharp dissection of nearby tissue
• Chemical or electrocautery required for hemostasis
• Additional infection risk for soft tissue that may require cosmetic repair with sutures following removal of the foreign body

Contraindications

Contraindications related to foreign body removal involve the following:^3,6

• Deep embedding
• Compromise of the integrity of nearby neurovascular or other structures during the retrieval process
• Poor or inadequate information on the position of the foreign body, leading to further exploration in the operating room
• Inadequate hemostasis or the potential for severe bleeding, especially if the patient has a clotting or bleeding disorder
• Cosmetic deformity related to the process of removal

Anesthesia

Local anesthesia provides the mainstay in pain control for foreign body removal.

• Lidocaine (with or without epinephrine), bupivacaine, and even topical lidocaine-epinephrine-tetracaine (LET) solutions or creams are useful in creating anesthesia at the site of exploration or removal.^16,3 For more information, see eMedicine topics Local Anesthetic Agents, Infiltrative Administration and Anesthesia, Topical.
• The field block and nerve distribution blocks at the sites of the wrist and ankle and at the bases of fingers or toes are useful anesthetic tools prior to a more extensive invasive evaluation or removal attempt.
• Removal of a nail through the hand or foot is aided by blocking the relevant nerve distributions prior to an attempt.^6,10
• Field blocks that surround the site of a splinter or staple entrance are essential for pain management during the procedure.
• A digital nerve block aids immensely the removal of a fish hook through a finger and also helps in postprocedure pain management.¹⁷

For detailed descriptions of various nerve blocks, please visit the Anesthetic and Analgesic Techniques section of eMedicine’s Clinical Procedures journal.

Equipment

• Imaging modalities and localizing skin markers for the detection of foreign bodies (described in Imaging section below)
• A surgical incision and drainage kit or a suture kit that contains the following:
  • Forceps
  • Kelly clamp
  • Chlorhexidine or other field sterilization cleansers
  • Drapes
  • Scalpel, No. 11
• Needle, small gauge
• Syringe, 10 mL
• Electro/chemical cautery tools¹⁶

Positioning

• Patient positioning is important to achieve several goals.
  • To dissipate force if substantial force is required
  • Comfort during extended removal period to relieve the patient of the burden of supporting a limb or other body part (Additional personnel or hardware may be required.)
  • Adequate visualization, inspection, and unhurried removal
  • Protection against trauma from a vasovagal episode
  • Protection of neurovascular structures in close proximity to the foreign body
• Various items may be helpful for proper positioning.
  • Padding
  • Temporary restraints
  • Pillows
• Adequate lighting, a seated position, and appropriate table and patient height can optimize the physician’s procedural outcome, as well.^16,3

Technique

No single technique is best for the removal of soft tissue foreign bodies.^{18,19,2,20,21,22,17,23,23,24,25,26} The following principles, however, can guide one’s choice of approach:

1. Obtain informed consent for the potential of future infection, pain, and disability.
2. Obtain necessary imaging information. If possible, use ultrasonography or fluoroscopy during removal.
3. Perform a detailed neurovascular examination.
4. Administer an adequate nerve block.
5. Use incisions, blunt dissection, and other methods that cause tissue deformation judiciously.
6. Use good surgical site bleeding control (eg, electrocautery, stitching, lidocaine with epinephrine) to create a bloodless field.
7. Provide detailed follow-up care instructions.
8. Consider antibiotic prophylaxis for excessively dirty wounds or in members of populations at risk for infection.
9. Update the patient’s tetanus status, as needed.

1. Apply a digital block to the affected finger.
2. Clip off the hook’s eye above the skin’s surface.
3. Advance the hook forward in a curvilinear fashion so that the barb protrudes through the skin again (superficially).
4. Continue to advance through the skin until the entire hook is removed.
5. This technique can prevent damage associated with removing the hook by retrograde traction, which would cause the barb to tear through tissue and skin on its way out.

Author strategy for traumatic nail removal. Cast cutter was used to remove shoe in which nail was embedded (propelled by a nail gun, nail traveled through top leather, sock, dorsum of foot, bone, sock, and rubber sole of shoe). Cast cutter used to cut away shoe and leave bare nail in foot. Nail was cut at surface of foot with bolt cutter and removed with steady pulling, with remaining nail fragment traveling from plantar to dorsal foot surface.

Photo of nail in foot, propelled by nail gun through soft tissue and bone.

Author placing ankle nerve block for traumatic nail removal.

Photo after nail removal. The patient suffered no acute complications from removal.

Pearls

• Adequate imaging that delineates the position, orientation, and depth of the foreign body is essential.
• Achieve adequate pain control through field blocks, digital blocks, or regional nerve blocks.
• Observe appropriate and bloodless-field techniques to safely and quickly remove the foreign body.²⁷
• For a successful outcome, the patient’s expectations need to be appropriate.^6,5 Explain the detection and removal processes to the patient, providing the caveats that a foreign body may not be amenable to removal and that infection may occur with or without removal.
• Always update the patient’s tetanus status, as needed.^16,2,28

Complications

Complications involving soft tissue foreign bodies comprise the following:^{8,11,10,29,15,14}

• Inadequate or missed diagnosis of a foreign body
• Inadequate determination of functional or neurovascular damage prior to foreign body removal
• Removal that is inappropriate, unsuccessful, or involves additional tissue damage
• Postprocedural retention of foreign body
• Postprocedural or retained foreign body infections and inflammatory reaction

The patient should be informed of the potential for these complications at every step of the way. Document that the patient received this information; adequate documentation may be useful if a poor outcome occurs.¹⁵

Imaging

Radiologic evaluation of soft tissue injuries with potential soft tissue foreign bodies is often an important adjunct in evaluating and planning the potential removal of the foreign body or identifying potential nearby structures, often vascular, that may be damaged during a retrieval procedure.

The following 5 imaging modalities¹⁶ are used in foreign body removal:

1. Conventional radiographs
2. Fluoroscopy
3. Computed tomography (CT)
4. Magnetic resonance imaging (MRI)
5. Ultrasonography

Radiograph

Radiographs are frequently the first step in foreign body evaluation. They are noninvasive, inexpensive, and can provide positional information, although not in real time, to aid in the removal of the foreign body.^17,16,30 Radiographs are most useful with radiopaque foreign bodies and can demonstrate sensitivities above 95% with adequate penetration and multiple views (anteroposterior and lateral).^17,16,18 Glass, which is frequently difficult to evaluate and remove, is often radiopaque even if not doped with lead. Plant-based foreign bodies, including bark or needles, plastics, and other polymers, are often radiolucent.^17,19,30,18 If appropriate radiolucent surface markers are used prior to the radiograph (ie, 2 surface paperclips, one in the anteroposterior and the other in the lateral plane), positional information of the foreign body relative to the surface markers can be used if a retrieval is planned.^20,21

Radiograph depicting foreign body projectile fragments in patient forearm.

Radiograph of foreign body fragments and projectile in patient forearm.

Fluoroscopy has some use in foreign body removal if a C-arm or other appropriate imaging equipment is accessible.²⁰ This technology allows for real-time radiographic visualization of the foreign body and affords the clinician the opportunity to precisely locate the foreign body using skin markers. One clinician described a technique in which, after a local field block, 2 small needles were placed and advanced into the skin at perpendicular angles under fluoroscopy until they were both touching the foreign body. An incision was then made to connect the 2 needles, and dissection (blunt) effected foreign body removal.

CT

CT has an important place as an imaging adjunct in the detection of and removal planning for soft tissue foreign bodies.^17,14 CT affords the ability to visualize foreign bodies that are radiolucent on conventional radiographs. It also provides detailed information about local anatomy, tissue reactions, and abscess formation, and it can more effectively demonstrate position and orientation of the foreign body. As such, it is a rich information set for the evaluation and detection of a foreign body and for the planning of the body’s removal.

CT is easily accessible in the emergency department, is more efficient than MRI, and provides substantial information for the resources invested.²³ The major drawback of CT may be that, like conventional radiographs and MRI, CT is not a dynamic modality for the emergency physician.

MRI

MRI is not used as frequently during the first clinician visit involving a foreign body. However, MRI can provide detailed information regarding tissue reactions, including chronic inflammatory reactions, osteoblastic or osteolytic changes, and secondary tissue reactions, that can aid in determining the presence and location of an otherwise occult foreign body. As an example of poor performance of MRI in the evaluation of foreign bodies, gravel particles, which are often ferromagnetic, cause significant streaking artifact on an MRI.^23,13 This streaking effect does not occur on plain films, CT, fluoroscopy, or ultrasound.

The use of MRI is limited because of the adequacy of other imaging modalities and the convenience of these modalities relative to MRI. However, MRI should be considered in cases of longstanding wounds or focal infections with unknown etiology in which the presence of a foreign body is being considered.^23,24

Ultrasonography

Perhaps the greatest advances in foreign body localization in soft tissue have been as a result of the move toward ubiquitous usage of diagnostic ultrasonography in the emergency department.^21,25 Many authors have described bedside ultrasonography, often with the usage of the linear probe and another visualization bladder (like a glove filled with saline or tap water), to be of great benefit in locating and removing soft tissue foreign bodies.^26,27,28 Ultrasonography affords the clinician real-time localization and orientation information and can also help in characterizing whether soft tissue edema or abscess is present. Since such findings are critical in both decision-making and in planning the removal of the foreign body, having them available via a convenient, dynamic bedside test is helpful.

Ultrasound of foreign body fragments and projectile in patient forearm.

Ultrasonographic guidance (active) of retrieval of foreign body fragments and projectile in patient forearm. Note tissue tenting at tip of forceps used to retrieve the most superficial fragment.

Ultrasound of remaining foreign body fragments and projectile in patient forearm after active ultrasound-guided removal of the most superficial fragment.

Foreign bodies are demonstrated as hyperechoic foci with shadows that depend upon the size and composition of the foreign body. Hyperechoic halos provide evidence of soft tissue inflammation or edema but can also indicate abscess or granulation tissue.²⁵ Because of their higher material densities, metallic or radiopaque foreign bodies often cause hyperechoic comet-tail artifacts.

Ultrasonographically based active guidance of foreign body removal is described by several authors as a technique that reduces procedural time, reduces morbidity, and improves time to detection and procedural outcomes.^21,25,12 However, using ultrasonography to detect foreign bodies raises serious issues. Some reports have demonstrated sensitivity rates below 50% for gravel, metal, wood, glass, and plastic with the use of ultrasonography, although more recent reports have improved sensitivities.

The use of ultrasonography in the detection and removal of soft tissue foreign bodies in the emergency department is growing and, as more emergency departments embrace ultrasonography as a technology suited for many purposes, may become as ubiquitous as conventional radiography in the evaluation of soft tissue foreign bodies.

Multimedia

Media file 1: 3-mm hole in patient forearm (entrance).

Media file 2: Radiograph depicting foreign body projectile fragments in patient forearm.

Media file 3: Radiograph of foreign body fragments and projectile in patient forearm.

Media file 4: Ultrasound of foreign body fragments and projectile in patient forearm.

Media file 5: Ultrasonographic guidance (active) of retrieval of foreign body fragments and projectile in patient forearm. Note tissue tenting at tip of forceps used to retrieve the most superficial fragment.

Media file 6: Ultrasound of remaining foreign body fragments and projectile in patient forearm after active ultrasound-guided removal of the most superficial fragment.

Media file 7: Author strategy for traumatic nail removal. Cast cutter was used to remove shoe in which nail was embedded (propelled by a nail gun, nail traveled through top leather, sock, dorsum of foot, bone, sock, and rubber sole of shoe). Cast cutter used to cut away shoe and leave bare nail in foot. Nail was cut at surface of foot with bolt cutter and removed with steady pulling, with remaining nail fragment traveling from plantar to dorsal foot surface.

Media file 8: Photo of nail in foot, propelled by nail gun through soft tissue and bone.

Media file 9: Author placing ankle nerve block for traumatic nail removal.

Media file 10: Photo after nail removal. The patient suffered no acute complications from removal.

References

1. Vermeiren B, De Maeseneer M. Medicolegal aspects of penetrating hand and foot trauma: ultrasound of soft tissue foreign bodies. JBR-BTR. Jul-Aug 2004;87(4):205-6. [Medline].

2. Chan C, Salam GA. Splinter removal. Am Fam Physician. Jun 15 2003;67(12):2557-62. [Medline].

3. Lammers RL, Magill T. Detection and management of foreign bodies in soft tissue. Emerg Med Clin North Am. Nov 1992;10(4):767-81. [Medline].

4. Dubay DA, Franz MG. Acute wound healing: the biology of acute wound failure. Surg Clin North Am. Jun 2003;83(3):463-81. [Medline].

5. Weigl DM, Bar-On E, Katz K. Small-fragment wounds from explosive devices: need for and timing of fragment removal. J Pediatr Orthop. Mar-Apr 2005;25(2):158-61. [Medline].

6. Snell JA. The management of dirt ingraining in wounds. Med J Aust. Mar 9 1968;1(10):401-4. [Medline].

7. Resnick CD, Fallat LM. Puncture wounds: therapeutic considerations and a new classification. J Foot Surg. Mar-Apr 1990;29(2):147-53. [Medline].

8. Brook JW. Management of pedal puncture wounds. J Foot Ankle Surg. Sep-Oct 1994;33(5):463-6. [Medline].

9. Chang HC, Verhoeven W, Chay WM. Rubber foreign bodies in puncture wounds of the foot in patients wearing rubber-soled shoes. Foot Ankle Int. May 2001;22(5):409-14. [Medline].

10. Hoffman DR, Jebson PJ, Steyers CM. Nail gun injuries of the hand. Am Fam Physician. Oct 15 1997;56(6):1643-6. [Medline].

11. Eylon S, Mosheiff R, Liebergall M, et al. Delayed reaction to shrapnel retained in soft tissue. Injury. Feb 2005;36(2):275-81. [Medline].

12. Rockett MS, Gentile SC, Gudas CJ, et al. The use of ultrasonography for the detection of retained wooden foreign bodies in the foot. J Foot Ankle Surg. Sep-Oct 1995;34(5):478-84; discussion 510-1. [Medline].

13. Hess U, Harms J, Schneider A, et al. Assessment of gunshot bullet injuries with the use of magnetic resonance imaging. J Trauma. Oct 2000;49(4):704-9. [Medline].

14. Marx JA. Foreign bodies. In: Marx JA, Hockberger RS, Walls RM. Rosen's Emergency Medicine: Concepts and Clinical Practice. 5^th ed. Elsevier; 2007:chap 57.

15. Pfaff JA, Moore GP. Reducing risk in emergency department wound management. Emerg Med Clin North Am. Feb 2007;25(1):189-201. [Medline].

16. Capellan O, Hollander JE. Management of lacerations in the emergency department. Emerg Med Clin North Am. Feb 2003;21(1):205-31. [Medline].

17. Gammons MG, Jackson E. Fishhook removal. Am Fam Physician. Jun 1 2001;63(11):2231-6. [Medline].

18. Blankstein A, Cohen I, Heiman Z, et al. Localization, detection and guided removal of soft tissue in the hands using sonography. Arch Orthop Trauma Surg. 2000;120(9):514-7. [Medline].

19. Bocka JJ, Godfrey J. Emergency department use of an eye magnet for the removal of soft tissue foreign bodies. Ann Emerg Med. Feb 1994;23(2):350-1. [Medline].

20. Crawford R, Matheson AB. Clinical value of ultrasonography in the detection and removal of radiolucent foreign bodies. Injury. Nov 1989;20(6):341-3. [Medline].

21. Eggers G, Haag C, Hassfeld S. Image-guided removal of foreign bodies. Br J Oral Maxillofac Surg. Oct 2005;43(5):404-9. [Medline].

22. Gahhos F, Arons MS. Soft-tissue foreign body removal: management and presentation of a new technique. J Trauma. Apr 1984;24(4):340-1. [Medline].

23. Isaacson G. Two-stage removal of an impacted foreign body with an epoxied anchor. Ann Otol Rhinol Laryngol. Sep 2003;112(9 Pt 1):777-9. [Medline].

24. Shalaev SA, Chepcheruk GS, Abakumov VA, Kurygin AA. [The removal of soft-tissue foreign bodies after the puncture administration of a dye]. Vestn Khir Im I I Grek. Jul-Dec 1993;151(7-12):46. [Medline].

25. Shiels WE 2nd, Babcock DS, Wilson JL, et al. Localization and guided removal of soft-tissue foreign bodies with sonography. AJR Am J Roentgenol. Dec 1990;155(6):1277-81. [Medline].

26. Siessegger M, Mischkowski RA, Schneider BT, et al. Image guided surgical navigation for removal of foreign bodies in the head and neck. J Craniomaxillofac Surg. Dec 2001;29(6):321-5. [Medline].

27. O'Brien M, Hutton KA. Minimally invasive retrieval of a foreign body after penetrating soft tissue injury. J Trauma. Sep 2005;59(3):754-6. [Medline].

28. Howell JM, Chisholm CD. Wound care. Emerg Med Clin North Am. May 1997;15(2):417-25. [Medline].

29. Smoot EC, Robson MC. Acute management of foreign body injuries of the hand. Ann Emerg Med. Jul 1983;12(7):434-7. [Medline].

30. Tountas CP, Macdonald CJ, Artman R. Case report. Detection of foreign bodies in the hand utilizing xeroradiography. Minn Med. May 1978;61(5):296-7. [Medline].

31. Blankenship RB, Baker T. Imaging modalities in wounds and superficial skin infections. Emerg Med Clin North Am. Feb 2007;25(1):223-34. [Medline].

32. Bodne D, Quinn SF, Cochran CF. Imaging foreign glass and wooden bodies of the extremities with CT and MR. J Comput Assist Tomogr. Jul-Aug 1988;12(4):608-11. [Medline].

33. Bonatz E, Robbin ML, Weingold MA. Ultrasound for the diagnosis of retained splinters in the soft tissue of the hand. Am J Orthop. Jun 1998;27(6):455-9. [Medline].

34. Cohen DM, Garcia CT, Dietrich AM, et al. Miniature C-arm imaging: an in vitro study of detecting foreign bodies in the emergency department. Pediatr Emerg Care. Aug 1997;13(4):247-9. [Medline].

35. Coombs CJ, Mutimer KL, Slattery PG, et al. Hide and seek: pre-operative ultrasonic localization of non radio-opaque foreign bodies. Aust N Z J Surg. Dec 1990;60(12):989-91. [Medline].

36. Donaldson JS. Radiographic imaging of foreign bodies in the hand. Hand Clin. Feb 1991;7(1):125-34. [Medline].

37. Friedman DI, Forti RJ, Wall SP, et al. The utility of bedside ultrasound and patient perception in detecting soft tissue foreign bodies in children. Pediatr Emerg Care. Aug 2005;21(8):487-92. [Medline].

38. Ginsburg MJ, Ellis GL, Flom LL. Detection of soft-tissue foreign bodies by plain radiography, xerography, computed tomography, and ultrasonography. Ann Emerg Med. Jun 1990;19(6):701-3. [Medline].

39. Gooding GA, Hardiman T, Sumers M, et al. Sonography of the hand and foot in foreign body detection. J Ultrasound Med. Aug 1987;6(8):441-7. [Medline].

40. Graham DD Jr. Ultrasound in the emergency department: detection of wooden foreign bodies in the soft tissues. J Emerg Med. Jan 2002;22(1):75-9. [Medline].

41. Healy C, Canney M, Murphy A, et al. Silver nitrate masquerading as a radiopaque foreign body. Emerg Radiol. Apr 2007;14(1):63-4. [Medline].

42. Krimmel M, Cornelius CP, Stojadinovic S, et al. Wooden foreign bodies in facial injury: a radiological pitfall. Int J Oral Maxillofac Surg. Oct 2001;30(5):445-7. [Medline].

43. Lejeune A, Nizet M. Detection of foreign bodies in hand. J Hand Surg [Am]. Jan 1993;18(1):166-8. [Medline].

44. Madan SI, Heilpern KL. Silver nitrate as a radiopaque foreign body. J Emerg Med. Nov-Dec 1999;17(6):1045. [Medline].

45. Manthey DE, Storrow AB, Milbourn JM, et al. Ultrasound versus radiography in the detection of soft-tissue foreign bodies. Ann Emerg Med. Jul 1996;28(1):7-9. [Medline].

46. Martins WD, Fávaro DM, Westphalen FH. Emergency maxillofacial radiology. Foreign body localization: report of cases. Dentomaxillofac Radiol. May 2005;34(3):189-92. [Medline].

47. Nelson EW, DeHart MM, Christensen AW, et al. Magnetic resonance imaging characteristics of a lead pencil foreign body in the hand. J Hand Surg [Am]. Jan 1996;21(1):100-3. [Medline].

48. Nosher JL, Siegel R. Percutaneous retrieval of nonvascular foreign bodies. Radiology. Jun 1993;187(3):649-51. [Medline].

49. Oikarinen KS, Nieminen TM, Makarainen H, et al. Visibility of foreign bodies in soft tissue in plain radiographs, computed tomography, magnetic resonance imaging, and ultrasound. An in vitro study. Int J Oral Maxillofac Surg. Apr 1993;22(2):119-24. [Medline].

50. Reiner B, Siegel E, McLaurin T, et al. Evaluation of soft-tissue foreign bodies: comparing conventional plain film radiography, computed radiography printed on film, and computed radiography displayed on a computer workstation. AJR Am J Roentgenol. Jul 1996;167(1):141-4. [Medline].

51. Russell RC, Williamson DA, Sullivan JW, et al. Detection of foreign bodies in the hand. J Hand Surg [Am]. Jan 1991;16(1):2-11. [Medline].

52. Smith JJ, Bennett NJ. A technique for localizing and removing a radio-opaque foreign body. Plast Reconstr Surg. Jul 2006;118(1):135-7. [Medline].

53. Stockmann P, Vairaktaris E, Fenner M, et al. Conventional radiographs: are they still the standard in localization of projectiles?. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. Oct 2007;104(4):e71-5. [Medline].

54. Storrow AB, Manthey DE. Ultrasound retrieval of foreign bodies. Ann Emerg Med. Jun 1997;29(6):779-8. [Medline].

55. Turkcuer I, Atilla R, Topacoglu H, et al. Do we really need plain and soft-tissue radiographies to detect radiolucent foreign bodies in the ED?. Am J Emerg Med. Nov 2006;24(7):763-8. [Medline].

56. Turner J, Wilde CH, Hughes KC, et al. Ultrasound-guided retrieval of small foreign objects in subcutaneous tissue. Ann Emerg Med. Jun 1997;29(6):731-4. [Medline].

Keywords

foreign body removal, foreign body, foreign body wound, soft tissue foreign body, fish hook, nail, impalement, occult trauma, occult foreign body, wound infection, shrapnel, fragment, splinter, staple, needle, bb, projectile, nail gun, bullet, knife removal, radiopaque foreign body, radiolucent foreign body, glass shard, glass shard removal, penetrating trauma, abrasive trauma, foreign body retention, foreign body infection, soft tissue injury, metal shard

Contributor Information and Disclosures

Author

Robert Edward Mittendorff II, MD, MBA, 
Robert Edward Mittendorff II, MD, MBA is a member of the following medical societies: American Medical Association and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Erik D Schraga, MD, Consulting Staff, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates; Consulting Staff, Permanente Medical Group, Kaiser Permanente, Santa Clara Medical Center
Disclosure: Nothing to disclose.

Medical Editor

Gil Z Shlamovitz, MD, Assistant Professor of Emergency Medicine, University of Connecticut School of Medicine; Attending Physician, Emergency Department, Windham Community Memorial Hospital, Willimantic, CT; Attending Physician, Emergency Department, Hartford Hospital, Hartford, CT
Gil Z Shlamovitz, MD is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Chief Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

The authors would like to thank the residents and attendings of the Stanford-Kaiser Emergency Medicine residency program for their anecdotal evidence on the techniques described and for specific case materials. 

© 1994- by Medscape.
All Rights Reserved
(http://www.medscape.com/public/copyright)