Soft Tissue Foreign Bodies

Richard L. Lammers

Pathophysiology C|inica|..,Featureis History

Physical, Examination

Diagnosis Plain,, Radiography

ultrasonography

Xeroradiography

Magnetic,, ResonanceJma.ging, ,,(MRI)

Treatment Genera^Principles

Methodsof Localization

Specific,, Foreign, ,Bodies,,and, Eemoyal, „Procedures Disposition

PostremoYalJreatm.e.nt Delayed,, .Removal

Chapter,, References

Soft tissue foreign bodies may be encountered when managing new wounds or evaluating complications of old wounds.1 When evaluating fresh injuries, the physician is responsible for detecting foreign bodies and for deciding if removal is urgent, can be delayed, or is even necessary. Many foreign bodies should be removed in the emergency department (ED); for example, all foreign material within the cavities of fresh lacerations should be irrigated away, debrided, or extracted with instruments. The decision to remove foreign bodies embedded below the dermal layer of skin depends on the size, location, composition, accessibility, and anticipated mechanical and inflammatory effects of the object. Occasionally, patients with subcutaneous foreign bodies should be referred to appropriate physicians for delayed removal.

Many foreign bodies are detectable during clinical examination, but some will not be apparent to the sight or touch of the examining physician. Various imaging studies can be used to evaluate wounds when nothing is found during exploration but the probability of a concealed object remains high; some foreign bodies, however, may not be visible with any type of radiographic or sonographic study. Consequently, malpractice actions for missed foreign bodies will continue to plague emergency physicians.

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