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Fishhook barbs often prevent backing the hook out of the puncture site. Several different methods have been described for removal.
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Management and Disposition
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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).
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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.
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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).
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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.
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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.
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