The occasional removal of an embedded fish hook.

This article has been peer reviewed. Fishing is a popular rural recreational activity involving millions of Canadians. Rural physicians can expect to see the occasional patient presenting with penetrating tissue trauma involving fish hooks. Management of an embedded hook includes taking a careful history, doing a physical examination of the hook injury and surrounding tissue and preparing the skin with antiseptic solution before attempting removal. Local anesthetic is probably necessary for all but the most superficially embedded hooks. Radiography may provide additional information with respect to presence of internally embedded barbs, depth of penetration or bony involvement. Complicated wounds, such as those involving the eye and those deeply embedded near tendons, blood vessels and nerves should be referred to more experienced specialists. Five fish hook techniques are described; namely, the 1) Simple Retrograde technique, 2) String-pull technique, 3) Advance-and-Cut technique, 4) Needle-Cover technique, and 5) Cut-it-Out technique. The technique chosen will depend on a number of variables, including the type of fish hook embedded, the anatomic location of the injury, the depth of tissue penetration and provider experience. The first 2 techniques result in the least amount of tissue trauma, can be performed with local anesthetic and should be attempted first, especially with barbless hooks and superficially embedded barbed hooks. Wound care following hook removal involves flushing any open wound with saline, applying topical antibiotic ointment and covering the wound with a simple dressing. The patient should be reminded about the risk of infection and told to return if signs of infection arise — erythema, discharge, pain and swelling. A followup appointment is organized as needed. Consideration should be given for the use of prophylaxis antibiotics, but they are generally not indicated. Tetanus status should be addressed before discharge.