J Korean Orthop Assoc.  2012 Apr;47(2):150-155. 10.4055/jkoa.2012.47.2.150.

Ultrasound-Guided Percutaneous Removal of Foreign Body Using Hydrodissection and Serial Dilators

• Lee SM
• Cho CH

• KMID: 2185392
• DOI: http://doi.org/10.4055/jkoa.2012.47.2.150

Abstract

High-resolution ultrasound of the painful, swollen left heel of a 54-year-old man, who reported that his symptoms had lasted 4 months, showed retention of a wooden foreign body in the heel. After administering local anesthesia and making a 5-mm skin incision, we performed hydrodissection of the foreign body from the adjacent soft tissue under real-time ultrasound guidance, using a 1% lidocaine solution. Then, we introduced an 18-gauge spinal needle and inserted a guide-wire through the needle. After we removed the needle, we introduced serial dilators in sizes ranging from 7 French to 12 French along the guide-wire to create a tract for mosquito forceps. Then, we introduced the mosquito forceps and removed the wooden foreign body. Ultrasound-guided percutaneous removal of foreign bodies is quick and safe. We believe that hydrodissection makes removal easier and that use of serial dilators minimizes soft-tissue injury and makes it easier to introduce mosquito forceps.

Keyword

foreign bodies; percutaneous removal; ultrasound

MeSH Terms

Anesthesia, Local
Culicidae
Foreign Bodies
Heel
Humans
Lidocaine
Middle Aged
Needles
Retention (Psychology)
Skin
Surgical Instruments
Lidocaine

Figure

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  Figure 1 A lateral plain radiograph of the left foot reveals diffuse soft-tissue swelling around the heel area but no evidence of a foreign body.

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  Figure 2 Longitudinal (A) and transverse (B) ultrasound scan images show a linear hyperechoic foreign body (arrowheads) with underlying acoustic shadowing within the abductor hallucis muscle (abh). (C) Color Doppler scan shows increased vascularity of the abductor hallucis muscle contained foreign body (arrowheads).

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  Figure 3 Longitudinal scan images show hydrodissection using 18-gauge spinal needle (white arrows) with 1% lidocaine solution deep to (A, B) and superficial to (C, D) the foreign body (arrowheads) to make easier removal.

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  Figure 4 (A) Instruments used to create a tract for introducing mosquito forceps using dilators: mosquito forceps, 18-gauge spinal needle, guide-wire, dilators. (B) After hydrodissection, an 18-gauge spinal needle was introduced and a guide-wire was inserted through it. (C) After removal of the spinal needle, serial dilators, from 7 French to 12 French, were introduced along the guide-wire to create a tract for the introduction of mosquito forceps, which minimized further soft-tissue injury.

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  Figure 5 (A-C) Serial ultrasound images of removal of the foreign body (arrowheads) with mosquito forceps (white arrows). (D) Removed wooden foreign body.

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