Korean J Radiol.  2015 Dec;16(6):1326-1331. 10.3348/kjr.2015.16.6.1326.

Ultrasound-Guided Percutaneous Removal of Wooden Foreign Bodies in the Extremities with Hydro-Dissection Technique

• Park HJ
• Lee SM
• Lee SY
• Son ES
• Chung EC
• Rho MH
• Lee SJ

• KMID: 2344288
• DOI: http://doi.org/10.3348/kjr.2015.16.6.1326

Abstract

OBJECTIVE
We described the technique of ultrasound (US)-guided percutaneous removal of the foreign bodies (FB) with hydro-dissection in the radiologic department and presented video files of several cases.
MATERIALS AND METHODS
Four patients referred to the radiology department for US evaluation and US-guided percutaneous removal of the FBs in the upper and lower extremities between November, 2006 and November, 2013 were included in this study. The procedures started with US evaluation for the exact location and shape of the FB. A 5 mm-sized skin incision was made at the site of the nearest point from the FB where no passing arteries or tendons were present. We adopted a hydrodissection technique to separate the FB from adjacent tissue using a 2% lidocaine solution. Injected anesthetics detached the FBs from surrounding tissue and thereby facilitated removal. After the tip of the mosquito forceps reached the FB, the wooden FBs were removed.
RESULTS
The mean time required for the entire procedure was approximately 20 minutes. There were no significant complications during the US-guided removal or long-term complications after the procedure. All 4 FBs were successfully removed from the soft tissue under US guidance.
CONCLUSION
Ultrasound-guided percutaneous removal of the FBs with hydro-dissection in the radiology department is a less invasive and safe method over surgical removal in the operating room. Additionally, the use of a guide wire and serial dilator may help minimize soft tissue injury and facilitate the introduction of forceps.

Keyword

Ultrasound; Intervention; Foreign bodies; Surgery

MeSH Terms

Aged
Child
Female
Foreign Bodies/*surgery/ultrasonography
Humans
Lower Extremity/*surgery/ultrasonography
Male
Middle Aged
Soft Tissue Injuries/*surgery/ultrasonography
Surgical Instruments

Figure

• 

  Fig. 1 Case of retained foreign body in 10-year-old male with complaint of knee pain after soccer. A. Plain radiography reveals diffuse soft tissue swelling in pre-patellar area but discrete foreign body is not seen. B, C. Ultrasound shows linear echogenic foreign body (arrows) with posterior shadowing superficial to patellar tendon. There is skin defect (arrowheads) with sinus tract from distal end of foreign body. Foreign body was removed with ultrasound guidance and hydro-dissection techniques. See also Video 1 in the onlineonly Data Supplement. D. Removed wooden foreign body.

• 

  Fig. 2 Case of retained foreign body in 64-year-old female who complained of painful wrist swelling for 1 week. Patient had history of stab injury with toothpick. A. Plain radiography reveals no discrete foreign body. B, C. Longitudinal (B) and transverse (C) ultrasonography show foreign body (arrows) surrounded by hypoechoic granulation tissue (asterisk). Foreign body was removed with ultrasound guidance and hydro-dissection techniques. Open arrow: median nerve, arrowhead: palmaris longus tendon. D. Removed wooden foreign body.

• 

  Fig. 3 Case of retained foreign body in 54-year-old male who complained of painful foot swelling for duration of 4 months. He received stab injury at construction site and removed rusted nail at time of original injury. A, B. Longitudinal (A) and transverse (B) ultrasounds show echogenic foreign body (between markers, arrows) in abductor halluces longus muscle. As foreign body was located in deep area and adhesion with surrounding soft tissue was suspected due to long term presence of FB, serial dilators with guide wire were employed. C. Guide wire was inserted through 18-G spinal needle. D. After removal of 18-G spinal needle, tract was dilated with 7 to 12 Fr serial dilators introduced along guide wire. E. Mosquito forceps (Halsted-Mosquito Forceps, 12 cm) were used to remove FB. FB = foreign body

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