Once a soft tissue foreign body is discovered, the physician must weigh the risk of leaving the foreign body in place against the potential harm of attempting to remove it. Not all foreign bodies must be removed, and not all that require removal must be extracted in the ED. However, every effort should be made to identify their presence during the initial visit. General indications for foreign body removal include potential for later infection, toxicity, injury, and functional problems ( T§bJ®.i2-2). Usually, objects that are small, inert, deeply embedded, and causing no symptoms can be left in place. A common question concerns bullets that come to rest deep within a muscle belly; they are usually not removed because the procedure can cause more damage than leaving the foreign object in place. Projectiles may drag bits of clothing or skin into the wound, so the entrance wound deserves cleaning and debridement. Bullet migration and embolization are rare but possible complications. Bullets near vessels can enter the systemic circulation. Bullets that cause distal ischemia, thrombus formation, or wall erosion or that lie within the lumen of a blood vessel require immediate removal in the operating room.
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