Depending on practice location and season of the year, the presentation
of a fishhook embedded in the subcutaneous tissue can be common.
Often, the patient or a well-meaning bystander will have already
attempted removal that was prevented by the hook’s barb.
Removal can be difficult as a fishhook is designed not to pull out
of a fish’s mouth. Several methods of removal have been described.1–5 The
method chosen depends on the type and size of the hook, the depth
of penetration, and the anatomical location of injury.
Most fishhooks become embedded in the skin and subcutaneous soft
tissue. The anatomy of a fishhook is simple (Figure 83-1). The long,
straight section is known as the shaft. The proximal end of the
shaft has a closed circle, the eyelet, where the fishing wire attaches.
The distal end of the shaft curves in a semicircle known as the
belly of the fishhook. The belly tapers into a sharp point with
a barb. The barb is usually located on the inner surface of the
hook, pointing away from the tip. The barb, once pierced through
the skin, becomes embedded within the tissue and prevents removal
of the fishhook. Additional barbs may be located along the shaft
of the fishhook.
Any embedded fishhook must be removed from the body. There is
no reason a fishhook should not be removed by the primary physician
or Emergentologist if no contraindication exists.
There are no absolute contraindications to fishhook removal.
Occasionally, the procedure should be referred to a consultant.
Globe perforation or laceration requires emergent consultation with
an Opthalmologist. Place the patient supine with a shield, not a
patch, over the eye. Please see Chapter 138 for the complete details
regarding eye patching and eye shields. Penetration
of, or near, vital structures (e.g., the neck, groin, or major neurovascular
structures) should be given consideration for the appropriate surgical
consultation prior to removal of the fishhook.
- Povidone iodine
- Local anesthetic solution without epinephrine
- 3 mL syringe armed with a 25 gauge needle
- Wire cutter
- Needle driver
- 18 gauge needle
- #11 scalpel blade on a handle
- String, fishing line, or a strong silk tie, at least 50 cm
- Safety glasses/goggles
Explain the risks and benefits of the procedure to the patient
and/or their representative. Obtain a signed consent form
prior to beginning the procedure. Cleanse the skin of any dirt and
debris. Apply povidone iodine to the skin surrounding the embedded
fishhook and allow it to dry.
This is the traditional method that is used for larger sized
hooks embedded in the soft tissue with the barb near the skin surface.
This is the preferred technique for fishhooks embedded in the ear,
a joint, ...