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The presentation of a fishhook embedded in the subcutaneous tissue can be common depending on practice location and season of the year. The patient, or a well-meaning bystander, will often have already attempted removal that was prevented by the hook’s barb. The ensuing tissue trauma and patient anxiety can complicate the task for the Emergency Physician. Removal can be difficult because a fishhook is designed not to pull out of a fish’s mouth. Several methods of removal have been described.1-19 The method chosen depends on the type and size of the hook, the depth of penetration, and the anatomic location of injury.


Most fishhooks become embedded in the skin and subcutaneous soft tissue. The anatomy of a fishhook is simple (Figure 124-1). 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. It can also be on outer surface of some hooks. 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.

FIGURE 124-1.

Anatomy of a fishhook.


Any embedded fishhook must be removed from the body. There is no reason a fishhook should not be removed by the Emergency Physician if no contraindication exists.


There are no absolute contraindications to fishhook removal. Occasionally, the procedure should be referred to a consultant. Globe perforation, globe laceration, and eyelid perforation require emergent consultation with an Ophthalmologist.10,11,13,14,18 Place the patient supine with a shield, not a patch, over the eye. Please see Chapter 193 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 or chlorhexidine solution

  • Local anesthetic solution without epinephrine

  • 3 mL syringe armed with a 25 gauge needle

  • Wire cutter

  • Needle driver

  • Hemostat

  • 18 gauge needle

  • #11 scalpel blade on a handle

  • String, fishing line, or a strong silk tie, at least 50 cm in length

  • Tongue depressors

  • Safety glasses/goggles or a face mask with an eye shield

The wire cutter and string need to be “clean” and not sterile. The patient’s skin as ...

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