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How To Remove a Deep Fishhook

By

Matthew J. Streitz

, MD, San Antonio Uniformed Services Health Education Consortium

Last full review/revision Sep 2020| Content last modified Sep 2020
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Fishhooks may become embedded deep in the subcutaneous or fascial layer of skin.

A deep fishhook is one that has penetrated to or past the curve of the hook—the barbed point is directed parallel to or even toward the skin surface and thus cannot be pulled out directly. Shallow fishhooks have a different removal technique.

Indications

  • Deeply embedded fishhook in skin

A fishhook in the globe of the eye should be managed by a specialist.

Contraindications

  • None

Complications

  • Infection

  • Chronic granuloma formation

Equipment

  • Cleansing solution, such as povidone-iodine or chlorhexidine

  • 21- and 25-gauge needles

  • 10-mL syringe

  • Local anesthetic, such as 1% lidocaine

  • #11 scalpel

  • Strong forceps or pliers

  • Strong wire cutters (eg, diagonal cutters)

  • Small, nonsterile paper or plastic cup

  • Nonsterile gloves

Relevant Anatomy

  • Rarely, hooks become embedded in or near important structures (eg, nerves, vessels, tendons) that must be taken into consideration during removal.

Positioning

  • Patient comfort with good lighting, excellent exposure of the fishhook, and support of the affected area on a firm surface

Step-by-Step Description of Procedure

  • Clean the site, including protruding hook, with povidone-iodine or chlorhexidine solution.

  • Determine the location of the point of the hook.

  • Ensure that there are no neurovascular structures or tendons between the point and the skin surface.

  • Inject local anesthetic into the area overlying and around the point.

  • Grab the shaft with pliers or forceps and advance the barb through the surface of the anesthetized skin.

  • Cover the point with the cup to catch the point as it flies off and clip the point and its barb off using strong wire cutters (1).

  • Back the remaining, barbless hook out of the skin.

  • Clean the area with soap and water or a mild antibacterial wound cleanser such as chlorhexidine. Bandage the wound.

  • Give tetanus toxoid-containing vaccine (eg, Td, Tdap) depending on patient's vaccination history (see table Tetanus Prophylaxis in Routine Wound Management). Incompletely immunized patients should also receive tetanus immune globulin 250 units IM.

Aftercare

  • Keep wound clean and dry and remove dressing after 48 hours.

  • With foot wounds, elevate extremity and limit ambulation for 1 to 2 days.

  • Return for evaluation for increased pain, redness, swelling, or other indications of infection.

  • Antibiotics are not used routinely, unless patient is immunocompromised.

No data support the routine use of antibiotics except possibly in immunocompromised patients. If given, use a first-generation cephalosporin or penicillinase-resistant penicillin, or for patients with contraindications to penicillins and cephalosporins, clindamycin, trimethoprim/sulfamethoxazole, or tetracycline.

Warnings and Common Errors

  • Rarely, a hook will be embedded within or underneath an important structure, and this advancement method could cause significant damage; open exploration should be done.

  • As with all puncture wounds, there is significant risk of infection.

  • Failing to cover the hook tip as it is cut will allow it to fly off at high speed, risking injury.

Tips and Tricks

  • Fishhooks are made of very strong steel; small wire cutters and bandage scissors are often inadequate to cut them.

  • If other methods are unsuccessful, it may be necessary to make an elliptical incision around the hook entrance.

  • Before removing a fishhook embedded in subungual tissue, use a digital block. Some cases require removing the nail or part of it to expose the hook.

Reference

Ahmad Khan H, Kamal Y, Lone AU: Fish hook injury: Removal by "push through and cut off" technique: A case report and brief literature review. Trauma Mon 19(2):e17728, 2014. doi: 10.5812/traumamon.17728

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