Fishhook barbs often prevent backing the hook out of the puncture site. Several different methods have been described for removal.
Management and Disposition
Adequate anesthesia, usually local, is essential for removal. Procedural sedation may be needed if a child has a fishhook embedded in a sensitive area (eg, eyelid).
The method used to remove the hook depends primarily on the location of the barb relative to the skin surface and the body part. The most common removal technique is the “push-through and cut.” This is recommended when the tip of the fishhook is close to breaking through the skin surface after being embedded (see figures and videos). Care should be taken when performing this maneuver in the hand or face as pushing the fishhook forward may damage nearby structures.
Superficially embedded hooks or hooks with small barbs may be removed in a retrograde fashion, by exerting pressure on the fishhook shaft toward the barb and backing the hook out through the original site of penetration. This technique can be performed manually or with the use of a string (see videos).
Once fishhooks are removed, the wound should be cleaned, irrigated, and left open. Antibiotics are usually not necessary; however, treatment (doxycycline) for Vibrio species (especially Vibrio parahaemolyticus) should be considered in wounds contaminated with saltwater.
Hooks embedded in cartilaginous structures, such as the ear or nose, are best managed with the push-through methods.
Hooks that penetrate joint spaces or bone should be managed in consultation with orthopedics.
Fishhooks that penetrate the globe of the eye are left in place, and emergent ophthalmologic consultation is obtained. The patient is placed in the semirecumbent position, and the globe is protected with an eye shield. Pressure patches are contraindicated, as they may extrude intraocular contents.
Fishhook Removal. Hooks with small superficially embedded barbs may be carefully backed out through the original puncture site (A and B). This may require a small incision, made in line with the concavity of the hook curve. The push-through technique is useful for large barbs or those more deeply embedded. The hook is pushed out through the skin, the barb removed, and the remainder of the hook subsequently removed through the original penetration site (C, D, and E). The traction (string) technique provides an alternative for removing hooks with small barbs. While pressing down on the shaft of the hook, traction is applied with 0 silk or umbilical tape. A swift yank of the cord in the direction opposite the barb will dislodge the hook (F). Care is taken to warn bystanders of the potential for the fishhook to fly across the room.
Multiple Pronged Fishhook....