Foreign Bodies in the Skin: Evaluation and Management
Am Fam Physician. 2020 Jun 15;101(12):740-747.
Author disclosure: No relevant financial affiliations.
Foreign bodies may be introduced into the skin through lacerations and soft tissue wounds. Long-term complications of retained foreign bodies include chronic pain and neurovascular impairment. Wound exploration and initial imaging with radiography or ultrasonography should be considered before foreign body removal. Risks and benefits of removal should be discussed with the patient. Although some foreign bodies may be left in place, removal should be considered if the risk of complications is high. A cooperative patient and adequate wound visualization are important for successful foreign body removal. Adequate analgesia and judicious use of anxiolytics and sedation may be helpful. Wound irrigation with normal saline or tap water is recommended after foreign body removal. Antiseptic solutions for wound irrigation may impair healing and should be avoided. Although there is no consensus on the use of antibiotic prophylaxis, several indications exist. The patient’s tetanus immunization history should be reviewed, and vaccine should be administered if indicated.
Soft tissue wounds are common injuries. In 2016, wounds were the primary diagnosis in 6.8 million emergency department visits in the United States.1 Wounds can contain foreign bodies, which may cause long-term complications if inappropriately managed, including neurovascular deficits and chronic pain.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.
Evaluation and Localization
Patients may not express concern for foreign bodies after an injury. However, the patient history may suggest that further evaluation is needed. The sensation of foreign bodies and trauma secondary to high-velocity projectiles or sharp, fragile objects should increase suspicion for foreign bodies.2 Careful visual inspection is necessary to assess for the presence of foreign bodies. Palpation around wounds may reveal tenderness. Metal instruments may
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