Items in AFP with MESH term: Wounds, Penetrating

Fishhook Removal - Article

ABSTRACT: Fishing is a common recreational sport. While serious injuries are uncommon, penetrating tissue trauma involving fishhooks frequently occurs. Most of these injuries are minor and can be treated in the office without difficulty. All fishhook injuries require careful evaluation of surrounding tissue before attempting removal. Ocular involvement should prompt immediate referral to an ophthalmologist. The four most common techniques of fishhook removal and injury management are described in this article. The choice of the method for fishhook removal depends on the type of fishhook embedded, the location of the injury and the depth of tissue penetration. Occasionally, more than one removal technique may be required for removal of the fishhook. The retrograde technique is the simplest but least successful removal method, while the traditional advance and cut method is most effective for removing fishhooks that are embedded close to the skin surface. The advance and cut technique is almost always successful, even for removal of large fishhooks. The string-yank method can be used in the field and can often be performed without anesthesia. Wound care following successful removal involves extraction of foreign bodies from the wound and the application of a simple dressing. Prophylactic antibiotics are generally not indicated. Tetanus status should be assessed and toxoid administered if needed.


Management of Foreign Bodies in the Skin - Article

ABSTRACT: Although puncture wounds are common, retained foreign bodies are not. Wounds with a foreign body sensation should be evaluated. The presence of wood or vegetative material, graphite or other pigmenting materials, and pain is an indication for foreign body removal. Radiography may be used to locate foreign bodies for removal, and ultrasonography can be helpful for localizing radiolucent foreign bodies. It is wise to set a time limit for exploration and to have a plan for further evaluation or referral. Injuries at high risk of infection include organic foreign bodies or dirty wounds. These should be treated with plain water irrigation and complete removal of retained fragments. In most cases, antibiotic prophylaxis is not indicated. If a patient presents with an infected wound, the possibility of a retained foreign body should be considered. Tetanus prophylaxis is necessary if there is no knowledge or documentation of tetanus immunization within 10 years, including tetanus immune globulin for the person with a dirty wound whose history of tetanus toxoid doses is unknown or incomplete.


Nerve Damage from Soft Tissue Injury to the Forearm - Photo Quiz


Growing Plantar Lesion Following Trauma - Photo Quiz


Evaluation and Management of Corneal Abrasions - Article

ABSTRACT: Corneal abrasions are commonly encountered in primary care. Patients typically present with a history of trauma and symptoms of foreign body sensation, tearing, and sensitivity to light. History and physical examination should exclude serious causes of eye pain, including penetrating injury, infective keratitis, and corneal ulcers. After fluorescein staining of the cornea, an abrasion will appear yellow under normal light and green in cobalt blue light. Physicians should carefully examine for foreign bodies and remove them, if present. The goals of treatment include pain control, prevention of infection, and healing. Pain relief may be achieved with topical nonsteroidal anti-inflammatory drugs or oral analgesics. Evidence does not support the use of topical cycloplegics for uncomplicated corneal abrasions. Patching is not recommended because it does not improve pain and has the potential to delay healing. Although evidence is lacking, topical antibiotics are commonly prescribed to prevent bacterial superinfection. Contact lens–related abrasions should be treated with antipseudomonal topical antibiotics. Follow-up may not be necessary for patients with small (4 mm or less), uncomplicated abrasions; normal vision; and resolving symptoms. All other patients should be reevaluated in 24 hours. Referral is indicated for any patient with symptoms that do not improve or that worsen, a corneal infiltrate or ulcer, significant vision loss, or a penetrating eye injury.



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