Foreign body?

When recent wounds are assessed, contamination by foreign material is systematically sought. If a foreign body is discovered in a wound or deeply embedded in the tissues, the physician must decide whether removal of the material is urgent, can be delayed, or even necessary. The decision to remove foreign bodies located below the dermal layer depends on the size, location, composition, accessibility, and anticipated mechanical and inflammatory effects of the object. Many foreign bodies can be removed in the emergency room. For example, all foreign materials in recent wound cavities should be irrigated, debrided, or removed with instruments. Occasionally, patients with subcutaneous foreign bodies should be referred to appropriate physicians for late removal.

Foreign bodies in soft tissue may be found when treating recent wounds or assessing complications from old wounds. The chapter reviews the effects of foreign bodies on soft tissues and methods for detecting and removing them.

Most, but not all, foreign bodies are detectable on clinical examination. Several imaging studies can be used to assess wounds when nothing is found during the examination, but there is a possibility that there is an object. However, some foreign bodies are not visible in radiographic or ultrasound studies, so the patient should be informed of this possibility and receive appropriate instructions at discharge.

Transient inflammation is an integral part of normal wound healing. A small amount of foreign bodies in a wound causes an inflammatory response in an effort to remove or contain the invading substance. When large amounts of devitalized tissue, foreign bodies, bacteria, and other irritants are found inside the wound, this protective response intensifies. Excessive or prolonged inflammation can delay wound healing or destroy the underlying soft tissue and bone, resulting in periosteal reactions, osteolytic lesions, synovitis, and arthritis. If a foreign body is not dissolved or expelled, it is encapsulated and creates a fibrous capsule. Once a foreign body is encapsulated, the inflammation subsides.

Most metals are inert, but oxidizing metals cause moderate to mild inflammation. Gold plated earrings cause inflammation of the earlobe and inflammation when the plated earring is detached. Foreign bodies of plant origin such as wood or spines trigger more intense inflammatory reactions. Spines.