Even if there were no relevant indications in the history, one should never lose sight of the possibility of the presence of a foreign body - in the case of limited pain, sensitivity, inflammation and weakening of function - since it is impossible to explain the disease by other causes.
Needles trapped in the body often cause almost no pain. So, sometimes by chance they find in the tissues a fragment of a needle, the ingress of which at one time patients attach little importance to and which they have completely forgotten.
Splinters and needles can easily get into the hands and in the knee area of children crawling on the floor, and with abscesses in these areas, this particular etiology should be suspected.
In cases of suppuration, the foreign body is usually found easily; if it is difficult to judge its location, then it is better to be satisfied with drainage for a few days than to lengthen the incision to an uninfected area.
Limited painfulness to pressure particularly clearly identifies the location of a foreign body. Taking into account the sensitivity caused by inflammation, if there is a point that is constantly the most painful, it directly indicates that a foreign body is located exactly in this place.
By making pressure with the tip of a finger or other instrument sequentially on one after another place of suspicious areas, the surgeon can either find only one painful point or one more painful than the rest of the surrounding areas. The points of the highest, painfulness usually correspond to the more superficially lying part of a foreign body, especially a needle or a sharp shard of glass, wood, etc., while points less painful outline the general direction of the body.
Stereoscopic radiography best of all marks the position and depth of a needle, a piece of glass, etc. If bismuth is rubbed into the skin earlier, then the depth of a foreign body from the surface can be very clearly seen.
You should not begin to remove a foreign body until you have definitely determined its position, if possible. If stereoscopic radiography does not provide guidance, you can use simple transillumination, turning the affected organ in different directions until it is possible to find out on the screen how the foreign body lies in relation to the bones.
To determine the location of a bullet, needle or other foreign body in different places of the head, neck, chest, thigh, etc., stereoscopic radiography can be combined with the method of mathematical localization by attaching one or more metal marks to the skin surface during transmission.
Fragments of sewing machine needles found in the tip of a finger are often stuck, even hammered tightly into the bone. When starting to remove such debris, it does not interfere with early stocking up with a small chisel and mallet, as well as strong tongs.
A fragment of a needle that has fallen into the muscular part of the palm of the hand can be significantly displaced in a few hours under the action of muscles that are very close to each other and are constantly in greater or lesser motion. To a much lesser extent, displacement is observed if the needle falls into the sole, where the main muscles lie deeper, less compact and where they are less mobile, and the dense plantar fascia retains a foreign body.
Foreign bodies in the palm, in accordance with the direction of the driving force, are often directed from the palm to the back of the hand and usually to the center of the palm. The shocks that they experience from the contracting muscles can move them further in the same directions. Most often, they stick into the flesh of the thumb or little finger.
Foreign bodies trapped in the foot are usually driven up and back. There are no abdominal muscles in the heel to cause progression. Therefore, it is unlikely that under the influence of pressure when walking, the latter could be significantly displaced.
When removing small foreign bodies, it does not interfere with the following rule at all: if the foreign body is superficial, then the incision is made in the direction of its axis; if the body lies deeper, then the incision should be made parallel to the fibers lying below the muscles.
Sometimes one end of the needle protrudes under the skin as soon as the muscles below the deeper end contract accordingly. In such cases, it is often possible to push the protruding tip through the skin and remove the needle without any incision.
Unless it is established that the foreign body lies far from the place where it entered, then this place, if only known, should be captured in the section for extraction. The place of entry of a foreign body must first be marked with a small injection of the skin.
When removing foreign bodies from the fingers, an incision should be made, if possible, in the spaces formed by the tendons in the midline and the vessels and nerves on the sides.
Fragments of hard wood trapped in the body, as well as shards of glass, can be encapsulated and often can be removed completely at one end. Splinters from a soft, especially old, tree break off when removed and, unless the wound is so open that it is possible to see the entire body that has fallen into it, even large fragments can remain unnoticed in the tissues.
When feeling for a needle or other foreign body, the tip of the finger is often much more useful than any probe. It should not be forgotten that the edges of the fascia often give a foreign body sensation under the probe. The incision and splitting of these tissues, deceiving your sensation, immediately greatly change the field of operation and violate the main anatomical relations.
It is highly desirable that, when finding a foreign body, tissue dissection should be carried out with systematic and quite distinct incisions.
A little patience, coupled with accurate localization and careful surgical technique, will usually lead to successful foreign body retrieval. On the other hand, when there is a lot of happiness, guesswork and guesswork lead to disappointment and failure.
When removing foreign bodies from the joint, even fingers wearing a sterile glove should not be left in the surgical wound longer than necessary.
A splinter in the skin is a situation familiar to the vast majority of adults and children. Mostly we splinter the skin on the hands, and the feet are the next most popular area of damage. As a rule, splinters of this localization are much more difficult to remove, which leads to suppuration and various complications of this process. A splinter in the foot can have especially serious consequences for the elderly, diabetics, as well as those with immunoglobulin A deficiency or systemic immunodeficiency.
Features of a splinter in the foot
The skin on the feet is designed for coarseness, so a splinter in the heel is an unusual condition for the body.
The skin on the feet of most people is quite dense, and anatomically designed for coarsening, which does not allow splinters at all.
Since we practically do not walk barefoot on the ground, and we are fiercely fighting against attempts at hormonal keratinization of the skin - our body is faced with a situation that, in principle, should not be.
The entire mass of the erect primate falls when walking on the foot, and not all at once - on the heel or on the toe. As a result, the splinter pierces deeply, the dense skin fixes the foreign body, and the base breaks off under pressure almost immediately.
Standard methods for removing splinters do not work here; special skill and preparation is required.
Preparing to remove a splinter from the foot
The splinter will not come out of the foot by itself
We must remember one simple fact - the splinter from the foot itself will not come out.
On the other hand, the density of the surrounding tissues and the anatomy of the foot prevent the rapid development of inflammation and pus. You have 6 hours to calmly prepare your skin and remove the foreign body. After this period, the process should take place with the participation of a general surgeon.
You can remove the splinter only by first softening the surrounding tissue. For this, there are a lot of lotions, including traditional medicine.
Recipes for lotions, pastes and ointments to soften the skin
A foot bath with salt or baking soda softens the skin well
The easiest way is to prepare a hot solution of table salt - put 1 tablespoon in half a liter of water, and soak the affected foot in it for 20-30 minutes, until the skin begins to gather in folds. After that, as a rule, the tip of the splinter is shown from the skin, i.e. you can carry out one or another manipulation to extract it.
If, for example, you cannot use a bath, for example, when a splinter is combined with a penetrating wound or with a fungal infection of the foot, you can use soda paste. The baking soda is diluted to a paste, then the resulting gruel is applied to the area of the splinter. Half an hour after that, the paste can be washed off, and the splinter can be removed.
Vishnevsky's ointment is an excellent emollient
An excellent emollient with an antiseptic and anti-purulent effect is tar and its derivative - Vishnevsky ointment. These products can not only soften the skin, but also draw pus out of the wound.
If the splinter is deep, and there is no access to the surgeon for some reason, the following method can be used: Vishnevsky's ointment is applied to the cleansed surface of the skin and fixed with a tampon and a plaster. Within 30-40 minutes you will receive the tip of the splinter (or all of it), and all the pus that has formed by this time.
Thermal baths are effective in the softening process
Thermal bath: pour boiling water with salt (100 g of salt per 400 ml of water) and quickly immerse and remove the foot from the solution (better - only the affected area) all the time while the brine cools down. After steaming, you can apply Vishnevsky ointment.
Sometimes a good effect is achieved with baths of a solution of baby soap - 100 g of soap per 400 ml of water, soak for 30 minutes.
Traditional methods of softening the skin before removing the splinter
Alternative methods include applications with a swab with aloe vera juice, banana peel or bread crumb.
It should be borne in mind that many folk methods aim only at stopping the local inflammatory process, and they will not help to extract the splinter itself.
Photo gallery: folk remedies for softening
Comfrey paste. The root of the comfrey grass is crushed, which must be poured with a small amount of boiling water until a thick paste is formed. A hot agent is placed on the affected area with a gauze swab and fixed with a bandage. Change the bandage every 4 hours until a splinter appears. After removing the splinter, treat the surface of the skin with alcohol and lubricate with calendula.
Onion gruel. The wiped fresh onion is fixed with a swab and fixed with a bandage, the bandage is changed after 4 hours.
Technique of removing a splinter from the foot
For the procedure, you will need tweezers, a magnifying glass, a needle, and rubbing alcohol. If you do not have any of the above, do not start the manipulation of removing the splinter (it is better to send someone to the store and pharmacy than to infect the wound).
Using a magnifying glass, we carefully study the area of the puncture, trying to find the tip of the splinter (with a splinter of the foot, this is impossible).
Photo Gallery: Extraction Tools
Even if the tip of the splinter is visible, it is impossible to pull out the splinter without softening the skin, since the high density of the surrounding tissues (with a splinter of the foot) will lead to a fracture of the rod of the foreign body - then it will be much more difficult to get it out.
Before manipulation, the needle and tweezers are treated with an antiseptic. It is best to carry out the manipulation with gloves (at least wash your hands).
When a splinter enters the body at a right (or close to right) angle, the sequence of actions is as follows:
- using a magnifying glass, determine exactly at what angle you need to pull the tip of the foreign body;
- using tweezers, pull the splinter along the penetration;
- examine the wound after extraction so that part of the splinter does not go unnoticed;
- treat the wound with alcohol, you can apply a medical patch.
If the splinter has entered parallel to the skin, then it is removed with a needle. To do this, gently pierce the softened skin under the splinter, and with a sharp tip squeeze the splinter to the puncture hole, and then intercept and pull it out with tweezers.
Be prepared that you will have to seek help from a specialist
If there is any doubt whether the whole splinter has come out, then it is necessary to apply Vishnevsky ointment after the manipulation - this will help get rid of the remnants of a foreign body.
If the place where the splinter was begins to redden, hurt and pulsate, this means that the purulent process could not be prevented. In this case, you must immediately contact the surgeon for assistance.
The abscess is opened, washed, local, and in severe cases, systemic antibacterial drugs can be prescribed.
It is quite simple to remove a splinter from the foot, observing the above principles. Adhere to the rules of antiseptics, take your time and you can come out victorious, even from a collision with the most unpleasant splinters.
Video: how to remove a splinter correctly
Life is full of surprises. And such seemingly small problems as splinters, chips, needles, glass shards, metal shavings, and much more can lead to unpleasant disappointing consequences. The busy life of the city sometimes leaves no time for itself, but this time must be found, at least in order to turn to a specialist if something happened.
Foreign bodies, getting into soft tissues, can stay there for a long time, unless, of course, they are accompanied by the development of infection, and they are forgotten. But this is rare. Most often, suppuration occurs in the area of foreign bodies trapped in the tissue. Suppuration is an inflammation, in the focus of which a cloudy yellow liquid (pus) is formed and secreted.
The affected areas are mainly open areas of the body, as a rule, arms, legs, less often on the buttocks, face, etc. A splinter in the fingers can be especially dangerous, since they generally wave a hand at it with the thought that it will somehow come out on its own, and in vain. The presence of a foreign body in the fingers can lead to panaritium.
Foreign bodies must be removed and abscesses must be opened.
Removing a splinter is not a very difficult procedure. It is necessary to disinfect the skin and the instrument with alcohol, 5% iodine tincture.
If a poisonous foreign body gets into the soft tissue, you should immediately consult a doctor. In addition, after an incident, which resulted in the ingress of a foreign body into the tissues, only a part of the foreign bodies located closer to the surface are often removed. The remains of the bodies may not be completely removed, but in such cases it remains.
Diagnostics of foreign bodies (glass, wood) presents some difficulties, with the exception of radiopaque bodies (metal). Removal of foreign bodies does not take long. Difficulties can arise when removing foreign bodies in the areas of the hands, feet and buttocks. Your doctor will usually give you tetanus toxoid and toxoid. Before the operation, anesthesia is performed, and the foreign body is marked under X-ray with metal needles brought to the foreign body in two planes. Removal takes place using the "fish hooks" method. The place where the hook is inserted and the exit zone of its sting is anesthetized with novocaine. The hook is pulled until the sting comes to the surface, after which the sting is bitten off, and the hook is pulled out in the opposite direction.
Do not delay the treatment, do not endure the pain, do not bring the wounds to suppuration! The development of purulent wounds requires special attention and treatment, mainly to avoid blood poisoning (sepsis), which can cause anaerobic or aerobic bacteria.
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Foreign bodies of the skin and soft tissues
A wide variety of foreign bodies are introduced by themselves or are introduced by children into the skin and soft tissues, usually during crawling or playing. These objects tend to be contaminated, and therefore puncture wounds should in most cases be regarded as infected. Therefore, it is necessary to prescribe antibiotics, guided by the size of the wound and the degree of its contamination. Tetanus prophylaxis is also carried out, determined by the nature of the vaccinations previously received by the child.The question often arises - to remove or not to remove a foreign body? As a rule, if a little time has passed after the injury and the foreign body is clearly identified, it should be removed. On the other hand, in the absence of symptoms, the risk of surgery to remove it outweighs the risk of finding a foreign body, and therefore it is best to leave it in place. In any case, the solution to this sometimes difficult issue depends on the nature of the foreign body and its localization.
Diagnosis is usually based on history. However, sometimes the child or parents are not sure if the injury really was. A conventional x-ray does not reveal all foreign bodies. Xero (electro) radiography and soft tissue radiography can provide essential assistance in detecting glass, plastic objects and wooden puppies.
Examination in transmitted light (transillumination) of small parts of the body, such as fingers, hand, leg, hand, foot, also helps to determine the presence and location of chips and splinters. In cases where a foreign head is located deep in muscles or subcutaneous fat, the study must necessarily be carried out in two projections, regardless of which method is used.
If only a foreign body is located not entirely superficially, then in young children it is most effective and least transmutable to remove it under general anesthesia. In older patients, when manipulating the hand and foot, regional blockade can be used. Local infiltration with anesthetics should, however, be avoided, as it leads to swelling, sometimes slight bleeding, and some tissue displacement, which can complicate an already difficult task.
Small, short pointed objects, such as needles, are especially difficult to remove because they are easily displaced and migrate deeper during surgery. It is much easier and more expedient to remove them using general anesthesia and performing the intervention under the control of a screen in the operating room. The incision should be small. A clamp is inserted through it, directing directly to the needle, which is grasped and, carefully maneuvering, is removed.
Woody foreign bodies. The tree is almost always contaminated, and therefore, in order to prevent infection, its pieces trapped in soft tissues must be removed. Soreness and flushing of the skin is usually noted around the inlet. If the chip is visible, local anesthesia can be used and it can be removed by grasping it with a forceps or by excising the tissue through a small incision directly above it. Deeply located chips or remnants of partially removed foreign bodies should first of all be clearly localized using xero- or soft-tissue radiography.
In the presence of multiple small pieces, it is more rational not to search for each one, but to excise the wound canal and all affected soft tissues containing foreign bodies, if localization allows this. Splinters under the fingernails or toenails should be removed by wedge-shaped excision of the nail covering the foreign body. This converts the anaerobic wound into an aerobic one and, in addition, the entire fragment can be removed without difficulty with this method.
Metal shards are usually smaller than wood chips and cause less severe reactions. They are especially difficult to detect as they can penetrate deep into soft tissue. Radiography almost always reveals metallic foreign bodies. If they are not clearly defined, then they should not be deleted.
Needles or parts of needles, if localized in soft tissue in the palm or foot, can be very troublesome. They enter through a small wound and are able to penetrate deeply, migrating with any movement. If an X-ray foreign body is detected, the limb should be immobilized immediately. For successful removal, general anesthesia, the application of a tourniquet, which allows the manipulation to be performed bloodlessly, and the possibility of using an X-ray screen, as described above, are required.
Sometimes an injection needle that has broken during medical manipulation remains in the soft tissues. These needles are usually sterile and do not require urgent removal, unless it is not difficult to remove them or when the patient has any symptoms.
If the needle broken off during the lumbar puncture remains in the spine, then after X-ray control, an operation is performed, which may not only be long-term, but sometimes even require removal of the vertebral arch or spinous process.
Fishing hooks are usually embedded in the fingers or palm. Their teeth make it very difficult to remove. A fish hook can be removed without much difficulty by pushing it forward with the sharp tip, poking it through the skin, and cutting off the barb.
Pieces of glass are often embedded in the hand or foot in children. In some cases, small fragments “splashed” on the face or body can be removed with an adhesive patch. Xeroentgenography usually reveals only significant pieces of glass in soft tissues. However, they are extremely difficult to detect during surgery. And since they are usually accompanied by minimal inflammation, they are removed later if pain or persistent signs of infection appear.
K.U. Ashcraft, T.M. Holder
A wide variety of foreign bodies are implanted on their own or injected into the skin. These items are most often contaminated, and therefore puncture wounds to the skin should in most cases be considered infected. Therefore, it is necessary to prescribe, guided by the size of the wound and the degree of its contamination. Tetanus prophylaxis is also carried out, determined by the nature of the previously received vaccinations.
The question often arises - to remove or not to remove a foreign body of the skin? As a rule, if a little time has passed after the injury and a foreign body of the skin is clearly identified, it should be removed. On the other hand, in the absence of symptoms, the risk of removal outweighs the risk of finding a foreign body, and therefore it is best to leave it in place. In any case, the solution to this sometimes difficult issue depends on the nature of the foreign body and its localization.
Diagnosis is usually based on history. A conventional X-ray does not reveal all foreign bodies in the skin. Electroradiography and soft tissue radiography can be of great help in detecting glass, plastic objects and wood chips. Study in transmitted light (transillumination) of small colors of the body, such as fingers, hand, leg, hand, foot, also helps to determine the presence and localization of chips and splinters. In cases where a foreign body is located deep in the muscles or in the subcutaneous fat, the study must necessarily be carried out in two projections, regardless of which method is used.
If only a foreign body of the skin is not completely superficial, then it is most effective and least traumatic to remove it under general anesthesia. When manipulating the hand and foot, a regional blockade can be applied. Local infiltration with anesthetics should, however, be avoided, as it leads to swelling, sometimes slight bleeding, and some tissue displacement, which can complicate an already difficult task. Small, short pointed objects, such as needles, are especially difficult to remove because they are easily displaced and migrate deeper during surgery. It is much easier and more expedient to remove them using general anesthesia and performing the intervention under the control of a screen in the operating room. The incision should be small. A clamp is inserted through it, directing directly to the needle, which is grasped and, carefully maneuvering, is removed.
Woody foreign bodies of the skin
The tree is almost always contaminated, and therefore, in order to prevent infection, its pieces trapped in soft tissues must be removed. Soreness and flushing of the skin is usually noted around the inlet. If the chip is visible, local anesthesia can be used and it can be removed by grasping it with a forceps or by excising the tissue through a small incision directly above it. Deeply located chips or remnants of partially removed foreign bodies should first of all be clearly localized using xero- or soft-tissue radiography. In the presence of multiple small pieces, it is more rational not to search for each one, but to excise the wound canal and all affected soft tissues containing foreign bodies, if localization allows this. Splinters under the fingernails or toenails should be removed by wedge-shaped excision of the nail covering the foreign body. This converts the anaerobic wound into an aerobic one and, in addition, the entire fragment can be removed without difficulty with this method.
Metallic foreign bodies of the skin
Metal shards are usually smaller than wood chips and cause less severe reactions. They are especially difficult to detect as they can penetrate deep into soft tissue. Radiography almost always reveals metallic foreign bodies. If they are not clearly defined, then they should not be deleted.
Needles or parts of needles, if localized in soft tissue in the palm or foot, can be very troublesome. They enter through a small wound and are able to penetrate deeply, migrating with any movement. If an X-ray foreign body is detected, the limb should be immobilized immediately. For successful removal, general anesthesia, the application of a tourniquet, which allows the manipulation to be performed bloodlessly, and the possibility of using an X-ray screen, as described above, are required.
Sometimes an injection needle that has broken during medical manipulation remains in the soft tissues. These needles are usually sterile and do not need to be removed urgently unless it is difficult to remove them or when the patient has any symptoms.
If the needle that broke off during the lumbar puncture remains in the spine, then after X-ray control, an operation is performed, which may not only be long-term, but sometimes even require removal of the vertebral arch or spinous process.
Fishing hooks are usually embedded in the fingers or palm. Their teeth make it very difficult to remove. A fish hook can be removed without much difficulty by pushing it forward with the sharp tip, poking it through the skin, and cutting off the barb.
Pieces of glass are often embedded in the hand or foot. In some cases, small fragments splashed on the face or body can be removed with an adhesive patch. Xeroentgenography usually reveals only significant pieces of glass in soft tissues. However, they are extremely difficult to detect during surgery. And since they are usually accompanied by minimal inflammation, they are removed later if persistent signs of infection appear.
The article was prepared and edited by: surgeon
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