Derm
Fishhook Removal
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Fishhook Removal
Preparation
Detach any connected fishing line
Tape or cut uninvolved hooks
Clean fishhook insertion site prior to removal
Topical
Povidone-Iodine
(
Betadine
) or
Hexachlorophene (
Hibiclens
)
Administer
Local Anesthesia
Surgeon to wear
Eye Protection
First-line Technique
Retrograde Technique
Indications
Barbless fishhook
Superficially embedded fishhook
Images
Retrograde Technique
Technique
See preparation above
Apply downward pressure to fishhook shank
Rotates hook deeper
Disengages barb if present
Back fishhook out of skin
Precautions
Stop procedure if resistance or catching occurs
First-Line Technique
String-Yank (Stream Technique)
Indications (do not use on earlobe)
Small and medium sized fish hooks
Deeply embedded fish hooks
Technique
See preparation above
Tie fishing line,
Suture
or umbilical tape onto hook
Tie at midpoint of bend in hook
Hold string tightly or attach to
Tongue
depressor
Stabilize involved skin against flat surface
Depress eye or distal shank as in Retrograde Method
Clear path of fishhook of people
Give string a firm, quick jerk
Resources
String Yank Technique (Image)
String Yank Technique (YouTube Video)
https://www.youtube.com/watch?v=ZRgH1oLMNnI
Second-Line Technique
Needle Cover Technique
Indications
Large hooks with single barbs
Barb superficially embedded
Images
Needle Cover Technique
Technique
See Preparation above
Advance 18 gauge needle along entrance of fishhook
Insert parallel to shank
Bevel pointing toward inside curve of hook
Longer edge of needle matches end of hook angle
Disengage barb by advancing fishhook
Pull and twist hook so hook point enters needle lumen
Back the needle and hook together out of the wound
Third-Line Technique
Advance and Cut Technique
Indications
Large fishhook
Fishhook near skin surface
Advantages
Highly successful technique
Disadvantages
Increased
Trauma
to surrounding tissue
Images
Advance and Cut Technique
Technique
See Preparation above
Advance hook/barb through skin (use needle driver)
Single Barb
Cut barb off and back hook through skin
Multiple Barbs
Cut off eye of hook and pull hook through skin
Post-operative wound care
Explore wound for additional foreign bodies
Do not
Suture
wound
Apply antibiotic ointment and bandage
Tetanus Prophylaxis
Prophylactic antibiotics indications
Immunocompromised
Diabetes Mellitus
Peripheral Vascular Disease
Deep wound involving
Muscle
, tendon or ligament
References
Cook (1981) Emerg Med 223 [PubMed]
Gammons (2001) Am Fam Physician 63(11):2231-6 [PubMed]
Haynes in Pfenninger (1994) Procedures, Mosby, p.128-32
Lantsberg (1992) Am Fam Physician 45(6):2589-90 [PubMed]
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