Ultrasound-guided removal of foreign bodies: personal experience

Abstract

Foreign bodies (FBs) retained in the soft tissues are a common reason for medical consultation, and usually consist of wooden or metal splinters or glass shards. Failure to remove foreign bodies is likely to give rise to acute or late complications, such as allergies, inflammation or infection, that may be severe. The surgical removal of an FB is invasive, costly and technically challenging. The procedure may fail in some cases and carries the risk of complications. Our study describes a technique for the ultrasound-guided removal of an FB, devised from our experience, and demonstrates its advantages over the standard surgical procedure. Sixty-two patients (43 males and 19 females aged from 9 to 65 years, median age 31 years) presented at our institution between October 2005 and June 2008 with suspected foreign bodies retained in the soft tissues of various body districts. Radiographic and/or ultrasound diagnosis was established by a radiologist expert in musculoskeletal sonography. The same radiologist helped by a nurse subsequently undertook the ultrasound-guided removal in the outpatient's clinic according to the technique described in the paper. ATL 5000 and PHILIPS iu22 ultrasound systems were used with high-frequency linear-array probes, sterile material, local anaesthetic (lidocaine 2%), scapels and surgical forceps. Antibiotic prophylaxis with amoxicillin and clavulanic acid were prescribed to all patients for 7 days after the procedure. Ninety-five FBs (39 glass, 35 metal, 17 vegetable, 2 plastic, 2 stone) were successfully removed under ultrasound guidance in all patients and the procedure took between 15 and 30 min. No complications arose either during or after the procedure. Seventy-five skin incisions were made and the wounds closed with Steri-Strips in 73/75 cases, whereas skin sutures were used in 2/75 cases. No complications arose either during or after the procedure. Ultrasound-guided removal of an FB retained in the soft tissues is a good alternative to surgery as is its relatively straightforward, inexpensive, repeatable and carries a low risk of complications. In addition, failure to remove an FB does not preclude traditional surgical removal. The advantages of this real-time procedure and the use of small instruments minimize bleeding time and avoid injury to surrounding structures. Patient compliance is enhanced by the fact that the procedure has little or no aesthetic impact. These encouraging results suggest ultrasound-guided removal as a first-choice procedure for the extraction of foreign bodies.

Wooden foreign bodies in soft tissue: role of tissue harmonic sonography

“…10 USG has been used not only for detection and localization but also to guide removal of the foreign bodies. 11,12 Our result showed that tissue harmonic sonography was 100% sensitive for the detection of the wooden foreign bodies.…”

Ultrasound picture of a wooden splinter evolved in phlegmon of the hand

“…Usually the foreign body is a splinter of wood or a sliver of metal or glass which needs prompt removal to avoid inconvenient short-or long-term complications such as inflammation, infection or allergy [1,2].…”

“…Diagnosis is easily made on the basis of clinical data including reference to an event which led to penetration by the foreign body and identification of a more or less extended area of inflammation. Removal of the foreign body is extremely important in order to avoid acute or chronic complications such as allergic reactions, inflammation or serious infections [1]. We report the US findings in a case where a wooden splinter had penetrated the subcutaneous soft tissues and caused formation of a phlegmon.…”

Diagnostic Accuracy of Ultrasonography in Retained Soft Tissue Foreign Bodies: A Systematic Review and Meta-analysis

“…After our complete review of these articles and their reference sections and our limited reviews of other databases, we included 17 articles in this metaanalysis (Table 1). All 17 studies [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] reported data for calculation of sensitivity; however, only 13 [23][24][25][26][27][28][29][30][31][32][33][34]36,37 reported data for calculation of specificity.…”