A Quick Synopsis of AFP's "Management of Foreign Bodies in the Skin"

Management of Foreign Bodies in the Skin
GWEN WAGSTROM HALAAS, MD, MBA, University of Minnesota Medical School, Minneapolis, Minnesota 
Am Fam Physician. 2007 Sep 1;76(5):683-691
http://www.aafp.org/afp/2007/0901/p683.pdf

     All penetrating skin injuries should be evaluated to rule out foreign bodies. Wounds should be evaluated within 24 hours, before the wound closes or inflammation, induration, and scarring sets in. Organic matter, such as wood, thorns or cloth, pose a higher risk of infection than inert matter, such as metal or glass. Pencil lead or graphite may leave a darkened "tattooing" and should be removed. 

   Penetrating wounds should be evaluated for nerve or vessel damage. Imaging is not necessary if the foreign object can be visualized. Depending on the material, a CT, x ray, or ultrasound can be used.  Removing a splinter can be done with tweezers if visualized. If not, the entry wound can be extended with a scalpel,  and opened up with a hemostat. It splinter has entered perpendicularly, or if it is deep in the fat, an elliptical area may need to be cut around the entry wound. pressure around the sides of the wound may help get the foreign body out, or the entire piece of flash may need to be removed. 

     Fishhooks can be removed in multiple ways. Hooks without a barb on the end can be removed by tractioning the hook in the reverse direction of the entry. If there is a barb at the end, as small gauge needle can be inserted alongside the hook to cover or "cap" the barb. downward pressure on the shank of the hook can help disengage the barb from the flesh while it is being removed. 

    Once the foreign body is removed, the wound should be flushed with tap water.  Using high pressure to clean the area may only drive foreign matter deeper into the wound.  Antiseptics such as hydrogen peroxide, chlorhexidine, and povidone iodine are toxic in open wounds. 

     Tetanus vaccine should be given to all wounded patients who have not had a booster in 10 years, those with an uncertain vaccination history, and those with dirty wounds who had not had a booster in five years. Tetanus Ig can be used in those with and uncertain history who have dirty wounds.