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How To Remove a Deep Fishhook

By

Matthew J. Streitz

, MD, San Antonio Uniformed Services Health Education Consortium

Reviewed/Revised Apr 2023
View PATIENT EDUCATION

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 How To Remove a Shallow Fishhook Fishhooks may become embedded in the subcutaneous layer of skin. A shallow fishhook is one that goes straight in and has not penetrated to the curve of the hook—the barbed point is directed... read more have a different removal technique.

Indications for Deep Fishhook Removal

  • Deeply embedded fishhook in skin

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

Contraindications to Deep Fishhook Removal

  • None

Complications of Deep Fishhook Removal

  • Infection

  • Chronic granuloma formation

Equipment for Deep Fishhook Removal

  • 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 for Deep Fishhook Removal

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

Positioning for Deep Fishhook Removal

  • 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 Deep Fishhook Removal

Aftercare for Deep Fishhook Removal

  • 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 for Deep Fishhook Removal

  • 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 for Removing a Deep Fishhook

  • 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

1. 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

Drugs Mentioned In This Article

Drug Name Select Trade
Betadine, Betadine Prep, First Aid, GRx Dyne, GRx Dyne Scrub, Povidex , Povidex Peri
Betasept, Chlorostat, DYNA-HEX, Hibiclens, Oro Clense , Peridex, Periogard, PerioRx , Perisol
7T Lido, Akten , ALOCANE, ANASTIA, AneCream, Anestacon, Aspercreme with Lidocaine, AsperFlex, Astero , BenGay, Blue Tube, Blue-Emu, CidalEaze, DermacinRx Lidocan III, DermacinRx Lidogel, DermacinRx Lidorex, DERMALID, Dologesic, Ela-Max, GEN7T, Glydo, Gold Bond, LidaFlex, LidaMantle, Lido King Maximum Strength, Lidocan, Lidocare, Lidoderm, LidoDose, LidoDose Pediatric, Lidofore, LidoHeal-90, LIDO-K , LidoLite, Lidomar , Lidomark, LidoPure, LidoReal-30, LidoRx, Lidosense 4 , Lidosense 5, Lidosol, Lidosol-50, LIDO-SORB, Lidotral, Lidovix L, LIDOZION, Lidozo, LMX 4, LMX 4 with Tegaderm, LMX 5, LTA, Lubricaine For Her, Lydexa, Moxicaine, Numbonex, ReadySharp Lidocaine, RectaSmoothe, RectiCare, Salonpas Lidocaine, Senatec, Solarcaine, SUN BURNT PLUS, Tranzarel, Xyliderm, Xylocaine, Xylocaine Dental, Xylocaine in Dextrose, Xylocaine MPF, Xylocaine Topical, Xylocaine Topical Jelly, Xylocaine Topical Solution, Xylocaine Viscous, Zilactin-L, Zingo, Zionodi, ZTlido
Cleocin, Cleocin Ovules, Cleocin Pediatric, Cleocin T, CLIN, Clindacin ETZ, Clindacin-P, Clinda-Derm , Clindagel, ClindaMax, ClindaReach, Clindesse, Clindets, Evoclin, PledgaClin, XACIATO
Primsol, Proloprim, TRIMPEX
Emtet-500, Panmycin, Sumycin
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NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
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