Foreignbody Removal

Obvious foreign debris should be carefully removed from the wound, with care to avoid injury to the physician from sharp edges or points. Retained foreign bodies can cause wound infections. Some diagnostic clues to the presence of a foreign body may include point tenderness or increased pain on range of motion, in conjunction with clinical suspicion. Visual wound inspection, down to the full depth and along the full course of the wound, is the most important method of detecting foreign bodies. Imaging modalities—plain radiology, ultrasound, computed tomography (CT), and magnetic resonance imaging—have a role in selected patients (see Chap 42, "Soft Tissue Foreign Bodies"). In general, glass, metal, and gravel fragments larger than 1 mm should be readily visible on plain radiographs taken with soft tissue technique and with multiple views to avoiding overlapping bone. Painted plastic and wood may be radiopaque and visible on plain radiographs. However, unpainted plastic or wood and other organic material is radiolucent and not routinely visible on plain radiographs. If these potential foreign bodies are suggested by the history and not detected during wound exploration, CT is the imaging modality most successful in detecting and locating such objects. Ultrasound, an attractive modality because of the lack of radiation exposure and the ability to image and assist during foreign-body removal, lacks sufficient sensitivity for soft tissue foreign-body detection and cannot be recommended as the sole imaging modality.

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