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![Disposition & Follow up
Wound care with thorough irrigation
If multiple radiopaque objects removed, post procedure
imaging to be done
Except clean wounds, prefer Delayed closure over Primary
closure.
Tetanus immunization
If a FB is near highly mobile area or joint, affected area should
be splinted before removal to prevent further injury or
migration of the object.
SPECIALITY CONSULTATION [ORTHO/ GEN/PLASTIC SURGERY]](https://image.slidesharecdn.com/softtissueforeignbody-161217110004/75/Soft-tissue-foreign-body-20-2048.jpg)
Uploaded byRunal Shah
Soft tissue foreign body
The document discusses the management of soft tissue foreign bodies, outlining their types, pathophysiology, clinical features, diagnosis, and treatment. Key points include inflammation responses to various foreign materials and the diagnostic imaging methods used to identify them. The document emphasizes careful exploration and management of wounds to prevent complications, including infections and the need for follow-up care.
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Soft tissue foreign body
- 1. Runal Shah 2nd yearMEM KDAH Soft Tissue Foreign Body
- 2. Objectives • Introduction • Patho-physiology •Clinical features • Diagnosis • Treatment • Disposition & Follow up
- 3. Introduction • Any objectbecomes a foreign body when it penetrates the skin and lodges in the soft tissue. • Most common : Wood, metal & glass • Inert (Nonreactive) o Bullets o Needles o Metallic items o Glass • Organic (Reactive) o Wood o Bone o Soil o Rubber o Thorns
- 4. Patho-physiology • Clean wound– transient inflammation • With foreign body – prolong inflammation, resistance or minimal response to Antibiotics/ NSAIDs/ Steroids • Material which are are inert, don’t elicit abnormal tissue response but metal with oxidized paint (Earring!!) causes moderate-severe inflammation • Vegetative FB, such as wood, thorns, and spines, trigger the most severe inflammatory reactions.
- 5. Patho-physiology • Local toxicreaction : Blackthorns, oils-resins of cedar splinters and redwood, sea-urchin spine, catfish spine • Rose thorn or cactus spine : allergic response to fungi on it • Systemic toxicity and Allergic reactions are unusual but most serious complications of FB. • FBs containing Lead can cause Lead poisoning if they are in contact with Pleural/Peritoneal/Joint/Cerebrospinal Fluid.
- 6. Patho-physiology • It canbe as a variety from – Local inflammation – Cellulitis – Abscess formation – Lymphangitis – Tenosynovitis – Bursitis – Septic Arthritis – Osteomyelitis • Infections are the most common complications of retained FBs. • Infections resolve spontaneously post foreign body removal • Plant thorn injury : Pantoea Agglumerans (enterobacteriacae) • Immunocompromised – fungal infections
- 7. Clinical Features • History –Mechanism of injury – Composition and shape of wounding object – Shape and location of resulting wound • Foreign body sensation in the healed wound • Persistent pain/ infection or pressure sensation with movement
- 8. Clinical Features • Physicalexamination Obtain good light and local anesthesia Before anesthetic is administered, gently run over your gloved finger over FB suspected region for eliciting characteristic sensation Local pressure >1min in a bleeding wound If bleeding continues, try a tourniquet for 15min, Sphygmomanometer BP cuff inflated above SBP with limb elevation
- 9. Diagnosis • Imaging 1. PlainRadiography – Most objects are readily visualized (80%) – Fragments >0.5 mm or large can be seen – Suspected sites multiple views can be taken up – Wood, thorns, chicken bones, plastics, some glass cant be seen 2. USG – Bedside tool – Prompt localization & assisted removal – Nonradiodense FB 1x2mm or larger can be detected – Operator dependent
- 10. Diagnosis • Imaging 3. CTscan – 100 times more sensitive in differentiating densities than X rays – Thorns, spines, wood splinters and toothpicks, fish bones, and plastic foreign bodies have been identified with CT – High cost, high radiation, wood FB mimic air bubbles 4. MRI – Non-metallic FBs can be detected accurately – Gravel/ metal containing FB have ferromagnetic streaks which obscures visualization – Exact location relating to anatomic structure can be sought
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- 19. Exploration in ED •Do not explore the following wounds in ED – Stab wounds to the neck, chest, abdomen, or perineum – Compound fracture wounds requiring surgery in theatre – Wounds over suspected septic joints or infected tendon sheaths – Most wounds with obvious neurovascular/tendon injury needing repair – Other wounds requiring special expertise (e.g. eyelids)
- 20. Disposition & Followup Wound care with thorough irrigation If multiple radiopaque objects removed, post procedure imaging to be done Except clean wounds, prefer Delayed closure over Primary closure. Tetanus immunization If a FB is near highly mobile area or joint, affected area should be splinted before removal to prevent further injury or migration of the object. SPECIALITY CONSULTATION [ORTHO/ GEN/PLASTIC SURGERY]
- 21. Ref : Tintinalli7/e Wounds and Lacerations by Alexander Trott 4/e Oxford Handbook of Emergency Medicine 4/e Medscape