Soft tissue metal foreign body removal

There are many types of soft tissue metal foreign objects, such as injection needles, needles, acupuncture needles, fish hooks, and bullets, shrapnel, and iron pieces left in soft tissues. Metal foreign bodies on the limbs are not in important parts, or metal foreign bodies are small, and do not cause any symptoms, generally do not need to take out, so as not to aggravate the damage. Treating diseases: swallowing foreign bodies, esophageal foreign bodies Indication 1. Large metal foreign bodies located in the vicinity of nerves, blood vessels or joints. 2. Although the metal foreign body is small (such as broken hips, etc.), it causes symptoms and hinders labor or daily life. Preoperative preparation 1. Correct positioning before surgery is an important step in removing soft tissue metal foreign bodies. The shallower foreign matter can be located in a relatively simple position; the shallower foreign body can be cut from the injured side; sometimes the foreign body is deep to the opposite side of the limb, and should be cut in and out on the opposite side. Generally, you should first position it under X-ray fluoroscopy to see where the foreign body is in the positive and lateral positions, and then turn the torso or limb to see where the metal foreign object is closest to the skin. Mark the point. After the skin is routinely disinfected, after the local anesthesia, the needle is inserted from this point (the length of the needle is determined by the depth of the metal foreign body), and the metal foreign object is touched with the needle under fluoroscopy. When it feels that it touches the metal foreign body or sees the metal foreign body, the needle is retained. As a marker, it is necessary to circulate the skin and then look for foreign objects. However, this needle is easily displaced during the process of separating the tissue, so that the effect of the label is lost, resulting in difficulty in surgery. In order to ensure the positioning and searching of foreign objects, the second positioning needle can be inserted at the same time, forming a right angle with the needle tip of the first needle, and intersecting at the foreign object. The function of the second positioning pin is: 1 the needle is not cut at the needle, it is not easy to move, and the positioning is guaranteed. If the first positioning pin fails, the needle can be used to find foreign objects. 2 Gently swing the needle tail by hand to find the tip of the needle in the incision. When separating, the feeling of hitting the tip of the needle is also easily transmitted to the needle tail part of the body. Therefore, when looking for foreign objects, first cut, separate, and search by the first positioning needle; if you can't find it, change to the second positioning needle, and then separate it to the needle tip to find the foreign object. 2. Inject tetanus antitoxin as appropriate. 3. For foreign bodies that are infected concurrently, the infection should be controlled first and then removed. Surgical procedure Take the broken needle on the hip as an example. 1. Incision: Generally, the cis skin, muscle fibers, tendons, nerves, and blood vessels are cut inward, and the incisions should be slightly larger. A slit of a long foreign body such as a broken needle is preferably at right angles to the long axis of the foreign object for easy searching. 2. Separation of tissue: According to the correct positioning before surgery, the skin is cut at the needle of the first positioning needle on the buttocks, the subcutaneous tissue is separated, the gluteal muscle fascia is exposed, the fascia is cut along the needle body, and the muscle fibers are separated until the foreign body is located. Part. Careful and light when separating, stop bleeding in time to keep the field clear and avoid foreign matter shifting. 3. Find and remove foreign objects: When the needle is positioned correctly, foreign objects can be found when separated to the tip of the needle. If it is not found, or the first positioning pin can not maintain its original position, you can pull it out and continue to search by the second positioning pin. You can also use a needle to probe the location of the foreign object. If the needle is broken, it should be found in the vertical direction of the long axis. After finding one end of the broken needle, it can be clamped with a curved hemostat and pulled out in the direction of the long axis of the needle; otherwise, it is easy to break and increase the difficulty of surgery. If it is a hook, the tail cannot be pulled out. It should be pushed forward in the arc of the hook to expose the hook, and then the hook tip is removed. Foreign objects such as wood thorns are easily broken and should be removed after being completely free. In addition, you should also pay attention to the removal of foreign matter such as cloth and cotton that will enter the wound. 4. Wound treatment: Generally, the incision can be sutured after the positioning needle is removed, but the drainage should be performed for those with serious pollution or infection, or the suture should be postponed.