Fishhook injury

Background

• Most commonly involve the hand, head, or face.
• Can be problematic to remove due to the large barb.
• Risk of retained foreign body if bait present on fishhook.

Removal Techniques

Simple Retrograde Technique

1. Press the external portion of the hook toward the skin to disengage the barb.
2. Slowly back the hook out of the skin.

Note: If the barb catches on skin fibers, other techniques must be used.

String-Pull Technique

1. String or suture is tied along the curve of the hook.
2. Press the external portion of the hook toward the skin to disengage the barb.
3. Rapidly pull the string in the opposite direction to remove the hook.

Note: This technique is associated with increased risk of tissue injury, increased pain, and may cause injury to health care providers from the flying hook. Therefore, this technique is rarely used in actual practice.

Needle-Cover Technique

1. An 18-guage needle is inserted through the skin alongside the shank of the hook.
2. The needle is advanced over the barb and the entire unit is reversed out.

Note: This technique requires great dexterity and is the least successful overall.

Advance and Cut Technique

1. Advance the hook forward until the edge (including the barb) have exited the skin.
2. Cut the barb outside of the skin.
3. Reverse the hook out of the skin.

Note: This method causes additional trauma and contamination (due to fishhook advancement) and is probably only warranted when the needle is already nearly exiting the skin.

Incision Technique

1. Using a #11 scalpel, enlarge the entrance wound 2-3 mm along the length of the hook until the barb is disengaged.
2. Slowly reverse the hook out of the skin.
3. A hemostat may be used to prevent the hook from snagging additional tissue.

Note: This is an excellent technique with great success, but caries the risk of additional neurovascular injury from the incision.

See Also

• Laceration repair
• Fingertip laceration

Authors

Michael Gottlieb, Neil Young, Ross Donaldson