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Emergency Fishhook Removal

 

While we are on the topic of Jetski fishing it would probably be a good time to talk about fishhook injuries. Remember to always carry a first aid kit and be prepare to look after yourself.

While serious injuries are uncommon, fishhooks injuries frequently occur. Most of these injuries are minor and can be treated immediately without difficulty. All fishhook injuries require careful evaluation of surrounding tissue before attempting removal. Eye injuries should prompt immediate professional medical help. 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 alcohol “oops” sorry I mean local anaesthesia. Wound care following successful removal involves extraction of foreign bodies from the wound and the application of a simple dressing. Tetanus status should be assessed and a dose administered if needed.

Persons with fishhook injuries may not present to hospital emergency departments because removal of the embedded fishhook or hooks can usually be done in the field. 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 for removing embedded fishhooks are described in this article

Patient Evaluation

Most fishhook injuries are penetrating soft tissue injuries to the hand, face, head or upper body but it can involve any body part. These injuries usually do not involve deeper tissue 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.
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FIGURE 1.

Types of fishhooks. (A) Simple-single barbed fishhook. (B) Multiple-barbed fishhook. (C) Treble fishhook.

Occasionally, more serious tissue trauma occurs from fishhook injury. While not routinely performed, x-rays may aid in determining the type of fishhook and the depth of penetration in difficult cases. Any fishhook injury that may involve deeper structures such as bone, tendons, vessels or nerves requires careful evaluation before attempting removal and in these cases “do not take the risk of permanent injury”. Seek medical help ASAP.

Principles of Removal

Four primary techniques have been described for the removal of fishhooks: retrograde, string-yank, needle cover, and advance and cut. Each method and some modifications to these techniques are described in detail in this article. “Note that that we take not responsibility for any injuries occurred while attempting these techniques. We recommend that professional medical advice should be sourced at all times”.

Most embedded fishhooks can be removed with minimal surgical intervention. Generally, the retrograde and string-yank methods should be the first techniques attempted because they result in the least amount of tissue trauma. The more invasive procedures, such as the needle cover and advance and cut techniques, are reserved for more difficult fishhook removal. Sometimes multiple techniques must be attempted before the fishhook is successfully removed.

Most removal methods require the administration of a local anaesthetic or a nerve block. Superficially embedded hooks may not require anaesthesia if they can be backed out or removed easily by the string-yank method.

Local care typically involves cleaning the site with povidone-iodine or hexachloro-phene solution before attempting removal of the fishhook. Saline irrigation may be required. Fishhooks with more than one point (i.e., treble fishhooks) should have the uninvolved points taped or cut to avoid imbedding these during the removal procedure.

Retrograde Technique

Retrograde technique is the simplest of the removal techniques but has the lowest success rate. It works well for barbless and superficially embedded hooks. Downward pressure is applied to the shank of the hook. This manoeuvre helps rotate the hook deeper and disengage the barb, if present, from the tissue. The hook can then be backed out of the skin along the path of entry (Figure 2). Any resistance or catching of the barb during the procedure should alert the physician to stop and consider other removal methods.

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FIGURE 2.

Retrograde technique. Downward pressure is applied to the shank of the fishhook while it is backed out along the point of entry.

String-Yank Technique

The string-yank technique is a highly effective modification of the retrograde technique and is also referred to as the “stream” technique. It is commonly performed in the field and is believed to be the least traumatic because it creates no new wounds and rarely requires anaesthesia. It may be used to remove any size fishhook but generally works best when removing fishhooks of small and medium size. This technique also works well for deeply embedded fishhooks, but cannot be performed on parts of the body that are not fixed (e.g., earlobe). Seek medical help because improper technique could cause further tissue damage.

A string, such as fishing line, umbilical tape or silk suture, should be wrapped around the midpoint of the bend in the fishhook with the free ends of the string held tightly (Figure 3). A better grip on the string can be achieved by wrapping the ends around a long item for grip. The involved skin area should be well stabilized against a flat surface as the shank of the fishhook is depressed against the skin. Continue to depress the eye and/or distal portion of the shank of the hook, taking care to keep the shank parallel to the underlying skin. A firm, quick jerk is then applied parallel to the shank while continuing to exert pressure on the eye of the fishhook. The fishhook may come out with significant velocity so the physician and bystanders should remain out of the line of flight.

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FIGURE 3.

String-yank method. (A) Wrap a string around the midpoint of the bend in the fishhook. (B) Depress the shank of the fishhook against the skin. (C) Firmly and quickly pull on the string while continuing to apply pressure to the shank.

Advance and Cut Technique

One advantage of this traditional method of fishhook removal is that it is almost always successful, even when removing larger fishhooks; however, additional trauma to the surrounding tissue is a disadvantage. The advance and cut technique is most effective when the point of the fishhook is located near the surface of the skin. It involves two methods of removal: one for single-point fishhooks (Figure 5) and one for multiple-barbed fishhooks (Figure 6). Using pliers or needle drivers, the point of the fishhook (including the entire barb) is advanced through the skin. The point is then cut free with the pliers or another cutting tool, allowing the rest of the fishhook to be backed out with little resistance.

cut method

FIGURE 5.

Advance and cut method: single-barbed fishhook. (A) The fishhook is advanced through the skin. (B)The barb is then cut off and (C) the remaining hook is backed out through the entry wound.

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FIGURE 6.

Advance and cut method: multiple-barbed fishhook. (A) The fishhook is advanced through the skin. (B) The eye of the fishhook is then cut off and (C) the remaining portion of the fishhook is pulled through the exit wound created by advancing the point.

For multiple-barbed fishhooks instead of removing the point, the eye of the fishhook is removed.

Post-Removal Wound Care

After removal of the fishhook, the wound should be explored for possible foreign bodies (e.g., bait). It is usually sufficient to leave the wound open, then apply an antibiotic ointment and a simple dressing. Tetanus toxoid should be administered to persons for whom more than five years has elapsed since their last tetanus booster. Follow-up professional medical care should be sourced to ensure adequate healing and the absence of infection.

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