Fishhook Removal -- American Family Physician

Patient Evaluation Most fishhook injuries are penetrating soft tissue injuries to the hand, face, head or upper extremity but can involve any body part. These injuries usually do not involve deeper tissue structures because of the linear forces applied along the fishing line to the fishhook that drive the point parallel to the skin and keep it from deep penetration. Many different types and sizes of fishhooks are available (Figure 1). When examining the hook, it is important to note if the fishhook is single, multiple or treble, whether the hook is barbed, and the number and location of the barbs—these details will help determine the best removal technique. Often, persons will know the type of hook they were using and may be able to provide a sample for inspection. Occasionally, more serious tissue trauma occurs from fishhook injury. While not routinely performed, radiographs may aid in determining the type of fishhook and the depth of penetration in difficult cases. Neurologic and vascular status, proximal and disA ngling is a popular sport worldwide, and fishhook injuries are common in recreational and commercial fishing settings. Persons with fishhook injuries may not present to the office or emergency department because removal of embedded fishhooks can usually be accomplished in the field. However, some embedded fishhooks cannot be removed in this manner and require evaluation of the injury and exploration of the wound for the presence of a foreign body. Four techniques Fishing is a common recreational sport. While serious injuries are uncommon, penetrating tissue trauma involving fishhooks frequently occurs. Most of these injuries are minor and can be treated in the office without difficulty. All fishhook injuries require careful evaluation of surrounding tissue before attempting removal. Ocular involvement should prompt immediate referral to an ophthalmologist. The four most common techniques of fishhook removal and injury management are described in this article. The choice of the method for fishhook removal depends on the type of fishhook embedded, the location of the injury and the depth of tissue penetration. Occasionally, more than one removal technique may be required for removal of the fishhook. The retrograde technique is the simplest but least successful removal method, while the traditional advance and cut method is most effective for removing fishhooks that are embedded close to the skin surface. The advance and cut technique is almost always successful, even for removal of large fishhooks. The string-yank method can be used in the field and can often be performed without anesthesia. Wound care following successful removal involves extraction of foreign bodies from the wound and the application of a simple dressing. Prophylactic antibiotics are generally not indicated. Tetanus status should be assessed and toxoid administered if needed. (Am Fam Physician 2001;63:2231-6.) Fishhook Removal