Surgery Book

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Fishhook Removal

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  1. Preparation
    1. Detach any connected fishing line
    2. Tape or cut uninvolved hooks
    3. Clean fishhook insertion site prior to removal
      1. Topical povidone-iodine (betadine) or
      2. Hexachlorophene (Hibiclens)
    4. Administer Local Anesthesia
    5. Surgeon to wear Eye Protection
  2. First-line Technique: Retrograde Technique
    1. Indications
      1. Barbless fishhook
      2. Superficially embedded fishhook
    2. Images
      1. Retrograde Technique
        1. FishHookRetro.jpg
    3. Technique
      1. See preparation above
      2. Apply downward pressure to fishhook shank
        1. Rotates hook deeper
        2. Disengages barb if present
      3. Back fishhook out of skin
    4. Precautions
      1. Stop procedure if resistance or catching occurs
  3. First-Line Technique: String-Yank (Stream Technique)
    1. Indications (do not use on earlobe)
      1. Small and medium sized fish hooks
      2. Deeply embedded fish hooks
    2. Images
      1. String Yank Technique
        1. FishHookYank.jpg
    3. Technique
      1. See preparation above
      2. Tie fishing line, Suture or umbilical tape onto hook
        1. Tie at midpoint of bend in hook
      3. Hold string tightly or attach to Tongue depressor
      4. Stabilize involved skin against flat surface
      5. Depress eye or distal shank as in Retrograde Method
      6. Clear path of fishhook of people
      7. Give string a firm, quick jerk
  4. Second-Line Technique: Needle Cover Technique
    1. Indications
      1. Large hooks with single barbs
      2. Barb superficially embedded
    2. Images
      1. Needle Cover Technique
        1. FishHookNeedle.jpg
    3. Technique
      1. See Preparation above
      2. Advance 18 gauge needle along entrance of fishhook
        1. Insert parallel to shank
        2. Bevel pointing toward inside curve of hook
        3. Longer edge of needle matches end of hook angle
      3. Disengage barb by advancing fishhook
      4. Pull and twist hook so hook point enters needle lumen
      5. Back the needle and hook together out of the wound
  5. Third-Line Technique: Advance and Cut Technique
    1. Indications
      1. Large fishhook
      2. Fishhook near skin surface
    2. Advantages
      1. Highly successful technique
    3. Disadvantages
      1. Increased trauma to surrounding tissue
    4. Images
      1. Advance and Cut Technique
        1. FishHookAdvance.jpg
    5. Technique
      1. See Preparation above
      2. Advance hook/barb through skin (use needle driver)
      3. Single Barb
        1. Cut barb off and back hook through skin
      4. Multiple Barbs
        1. Cut off eye of hook and pull hook through skin
  6. Post-operative wound care
    1. Explore wound for additional foreign bodies
    2. Do not Suture wound
    3. Apply antibiotic ointment and bandage
    4. Tetanus prophylaxis
    5. Prophylactic antibiotics indications
      1. Immunocompromised
      2. Diabetes Mellitus
      3. Peripheral Vascular Disease
      4. Deep wound involving muscle, tendon or ligament
  7. References
    1. Cook (1981) Emerg Med :
    2. Gammons (2001) Am Fam Physician 63(11):2231
    3. Haynes in Pfenninger (1994) Procedures, Mosby, p.128-32
    4. Lantsberg (1992) Am Fam Physician 45(6):2589

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