Fishhook injury

Background

• Most commonly involve the hand, head, or face.
• Can be problematic to remove due to the large barb.
• Risk of retained foreign body if bait present on fishhook.

Removal Techniques

Simple Retrograde Technique

1. Press the external portion of the hook toward the skin to disengage the barb.
2. Slowly back the hook out of the skin.

Note: If the barb catches on skin fibers, other techniques must be used.

String-Pull Technique

1. String or suture is tied along the curve of the hook.
2. Press the external portion of the hook toward the skin to disengage the barb.
3. Rapidly pull the string in the opposite direction to remove the hook.

Note: This technique is associated with increased risk of tissue injury, increased pain, and may cause injury to health care providers from the flying hook. Therefore, this technique is rarely used in actual practice.

Needle-Cover Technique

1. An 18-guage needle is inserted through the skin alongside the shank of the hook.
2. The needle is advanced over the barb and the entire unit is reversed out.

Note: This technique requires great dexterity and is the least successful overall.

Advance and Cut Technique

1. Advance the hook forward until the edge (including the barb) have exited the skin.
2. Cut the barb outside of the skin.
3. Reverse the hook out of the skin.

Note: This method causes additional trauma and contamination (due to fishhook advancement) and is probably only warranted when the needle is already nearly exiting the skin.

Incision Technique

1. Using a #11 scalpel, enlarge the entrance wound 2-3 mm along the length of the hook until the barb is disengaged.
2. Slowly reverse the hook out of the skin.
3. A hemostat may be used to prevent the hook from snagging additional tissue.

Note: This is an excellent technique with great success, but caries the risk of additional neurovascular injury from the incision.

Antibiotics

Following is from article on Fish Hook Removal from Don't Forget the Bubbles.

No clinical trial to date has addressed the need for empirical antibiotics in fishhook wounds. In general, empirical antibiotics are prescribed.

If the hook was not contaminated, empiric antibiotics for skin flora is recommended. Treat as if there might be uncomplicated cellulitis and follow local guidelines.

If the hook was contaminated, consider other pathogens including Aeromonas, Edwardsiella tarda, Vibrio vulnificus and Mycobacterium marimun. Use an oral first-generation cephalosporin or, in patients with acephalosporin allergy, oral clindamycin, plus an oral fluoroquinolone such as levofloxacin. If there is seawater exposure, add doxycycline to cover for Vibrio (although avoid in children under 8 as it causes teeth discolouration and enamel hypoplasia). If there was soil contamination or exposure to sewage-contaminated water, add metronidazole to cover for anaerobes, unless you are already using clindamycin.

See Also

• Laceration repair
• Fingertip laceration

External Links

Videos

{{#widget:YouTube|id=YyymouV8ulU}}