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Lukish JT, Williams K, Shah A, Mon R, Lukish JR. The Novel Use of Rare Earth Magnets for the Extraction of Metallic Soft Tissue Foreign Bodies in Children. Surg Innov 2023; 30:571-575. [PMID: 36916247 DOI: 10.1177/15533506231158209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
INTRODUCTION Metallic foreign bodies (mFB) are common following penetrating injuries in children. The mFB commonly occur in the head and neck region and extremity soft tissues. Removal may be indicated due to morbidity related to pain or migration. Extraction can be challenging to localize, often requiring wide exposure, and may be difficult to achieve in cosmetically sensitive areas. Different technological adjuncts have been used to facilitate foreign body removal including fluoroscopy, ultrasound, and more recently in adults, surgical magnets. The most powerful commercially available magnets are rare earth magnets comprised of neodymium iron and boron (Ndy). With the goal of reducing radiation exposure and the morbidity of mFB removal with associated soft tissue injury in children, a strategy was introduced utilizing Ndy to optimize extraction with minimal soft tissue surgical dissection. MATERIALS AND METHODS Two children with extremity mFB treated with Ndy between January 2021 and July 2021 were analyzed. We utilized commercially available ring type neodymium-iron-boron magnets with dimensions of 1 3/8-inch outer diameter x 1/8-inch inner diameter and 1/16 inch thick with a power of 13 200 gauss that were processed for use according to our hospital protocols. Our main clinical indication was for the detection and retrieval of small ferromagnetic foreign bodies embedded in superficial extremity soft tissues. RESULTS In the operating room under general anesthesia, the mFB were localized utilizing fluoroscopy. A 1.0 cm skin incision was made into the subdermal soft tissues overlying the area of the mFB. No surgical tissue dissection was performed. The mFB could not be visualized in the soft tissue. Using fluoroscopy to localize the mFB, the Ndy was then placed into the wound in close proximity to the mFB. The mFB were immediately magnetized to the Ndy and the mFB were extracted from the soft tissues without any further surgical dissection. Two simple interrupted nylon sutures were placed to close the incision. The total operative time was 2 and 2.5 minutes respectively. The children recovered uneventfully and are without complication. CONCLUSIONS The use of Ndy to remove extremity soft tissue mFB in children appears to be feasible, safe, and efficient. Use of the Ndy allowed extraction via a small incision, optimizing the aesthetic result and avoiding the need for cross-sectional imaging, extensive surgical dissection, tissue reconstruction and prolonged operative time or x-ray exposure. The development of magnets of increasing energy density may be indicated to further optimize metallic soft tissue foreign body extraction in children in a minimally invasive manner.
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Affiliation(s)
- John T Lukish
- Kansas City University of Medicine and Biosciences, Kansas City, MO, USA
| | - Kibileri Williams
- Division of Pediatric Surgery, Children's National Hospital, Washington DC, USA
| | - Adil Shah
- Division of Pediatric Surgery, Children's National Hospital, Washington DC, USA
| | - Rodrigo Mon
- Division of Pediatric Surgery, Children's National Hospital, Washington DC, USA
| | - Jeffrey R Lukish
- Division of Pediatric Surgery, Children's National Hospital, Washington DC, USA
- Sheik Zayed Institute for Pediatric Surgical Innovation, Washington DC, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- The George Washington University, Washington, DC, USA
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Colmers-Gray IN, Crawshay A, Budden C. Minor injuries: laceration repairs. BMJ 2023; 380:e067573. [PMID: 36639152 DOI: 10.1136/bmj-2021-067573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
| | - Aven Crawshay
- Prince Rupert Regional Hospital, Prince Rupert, British Columbia, Canada
| | - Curtis Budden
- University of Alberta, Faculty of Medicine and Dentistry, Department of Surgery, Edmonton, Alberta, Canada
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Truong DH, Fontaine JL, Malone M, Wukich DK, Davis KE, Lavery LA. A Comparison of Pathogens in Skin and Soft-Tissue Infections and Pedal Osteomyelitis in Puncture Wound Injuries Affecting the Foot. J Am Podiatr Med Assoc 2022; 112:20-206. [PMID: 33141882 DOI: 10.7547/20-206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 10/03/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND To compare pathogens involved in skin and soft-tissue infections (SSTIs) and pedal osteomyelitis (OM) in patients with and without diabetes with puncture wounds to the foot. METHODS We evaluated 113 consecutive patients between June 1, 2011, and March 31, 2019, with foot infection (SSTIs and OM) from a puncture injury sustained to the foot. Eighty-three patients had diabetes and 30 did not. We evaluated the bacterial pathogens in patients with SSTIs and pedal OM. RESULTS Polymicrobial infections were more common in patients with diabetes mellitus (83.1% versus 53.3%; P = .001). The most common pathogen for SSTIs and OM in patients with diabetes was Staphylococcus aureus (SSTIs, 50.7%; OM, 32.3%), whereas in patients without diabetes it was Pseudomonas (25%) for SSTIs. Anaerobes (9.4%) and fungal infection (3.1%) were uncommon. Pseudomonas aeruginosa was identified in only 5.8% of people with diabetes. CONCLUSIONS The most common bacterial pathogen in both SSTIs and pedal OM was S aureus in patients with diabetes. Pseudomonas species was the most common pathogen in people without diabetes with SSTIs.
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Affiliation(s)
- David H Truong
- *Surgical Service, Podiatry Section, Veterans Affairs North Texas Health Care System, Dallas, TX
- †Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Javier La Fontaine
- †Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
- ‡Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Matthew Malone
- §Infectious Diseases and Microbiology, School of Medicine, Western Sydney University, Sydney, Australia
- ‖South West Sydney Limb Preservation and Wound Research, Liverpool Hospital, South Western Sydney LHD, Sydney, Australia
| | - Dane K Wukich
- †Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Kathryn E Davis
- ‡Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Lawrence A Lavery
- †Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
- ‡Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
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Abstract
Ultrasound-guided regional anesthesia is a growing modality within the pediatric emergency department. Here we present a case where a posterior tibial nerve block was used for anesthesia during foreign body removal from the plantar foot. We further review the technique and literature regarding this straightforward and highly effective procedure.
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Ernst JJ, Ryba D, Brower B. Retrograde dorsalis pedis angiosomal flow compromised by small puncture wound leading to transmetatarsal amputation. Foot (Edinb) 2019; 39:60-67. [PMID: 30974342 DOI: 10.1016/j.foot.2019.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 02/03/2019] [Accepted: 02/10/2019] [Indexed: 02/04/2023]
Abstract
Pedal puncture wounds can precipitate a variety of complications, often resulting from a delay in treatment. Although the risk of infection predominates, direct vascular insult and subsequent ischemia is a lesser reported complication of these injuries. Consequently, this may have morbid results, especially on a background of pre-existing peripheral vascular disease. A case involving a small, plantar forefoot puncture wound, ultimately resulting in transmetatarsal amputation due to ischemic dry gangrene in an uncontrolled, but sensate, diabetic with profound vasculopathy is presented. This presentation highlights the importance of considering the potential for macrovascular damage via pedal puncture, and the potentially magnified complications in patients with dependent retrograde angiosomal flow and compromised collateral circulation. Based on a thorough analysis of the literature and the findings in this clinical example, a detailed investigation of angiosomal blood supply through direct and indirect vessel flow in patients with peripheral arterial disease incurring puncture wounds is advocated. In these patients, lack of compensatory avenues of the pedal circulation may portend significant tissue loss in an otherwise inoffensive situation. Knowledge of this complication, although rare, may prompt the clinician to assess for its potential, and emphasize a preference for direct revascularization in those with critical limb ischemia. Level of Clinical Evidence: 4.
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Affiliation(s)
- Jordan James Ernst
- Foot and Ankle Surgery Resident, Dept. of Orthopedics, John Peter Smith Hospital, 1500 S. Main Street, Fort Worth, TX, 76104, United States.
| | - Dalton Ryba
- Foot and Ankle Surgery Resident, Dept. of Orthopedics, John Peter Smith Hospital, 1500 S. Main Street, Fort Worth, TX, 76104, United States
| | - Brittany Brower
- Foot and Ankle Surgery Resident, Dept. of Orthopedics, John Peter Smith Hospital, 1500 S. Main Street, Fort Worth, TX, 76104, United States
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Plantar and Pedal Puncture Wounds in Children: A Case Series Study From a Single Level I Trauma Center. Pediatr Emerg Care 2017; 33:724-729. [PMID: 26785095 DOI: 10.1097/pec.0000000000000615] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The purpose of this study was to describe our experience in treatment of pediatric patient presenting with pedal puncture wound to our level I trauma center and describe our results for the need for hospitalization and/or surgery for these patients. METHODS Children and adolescents 18 years and younger presenting with pedal puncture wounds from September 2009 to December of 2013 were retrospectively studied. Exclusion criteria included adult patients, wounds related to animal bites, lacerations associated with a motor vehicle collision or all-terrain vehicle accidents, gunshot wounds, degloving injuries, or injuries resulting in complex lacerations to the foot. RESULTS A total of 147 children presented to emergency department (ED) with a pedal puncture wound. Average age was 9.8 years. Prophylactic antibiotic therapy was administered in 107 cases (72.8%). Fifteen patients (10%) were treated with intravenous or intramuscular antibiotics in the ED or after hospital admission, 81 patients (55%) were treated with oral medications (prescribed for them to be taken after discharge), and 35 patients (24%) received topical antibiotic treatment. Of the 147 patients included in the study, 9 patients (6%) required the need for hospitalization. Two patients were admitted for parenteral antibiotic treatment only, and 7 patients required formal surgical debridement in the operating room in addition to parenteral antibiotic therapy. CONCLUSIONS The majority of pediatric patients with pedal puncture wounds were treated in the ED with only a small percentage of patients requiring admission for either parenteral antibiotic treatment or formal surgical debridement.
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Jones MD, Sweet KJ, Hoffer ZS. Retained viable plant material in the calcaneus: a case report of a 22-year-old soldier with atypical heel pain. J Am Podiatr Med Assoc 2016; 105:92-5. [PMID: 25675232 DOI: 10.7547/8750-7315-105.1.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Foreign bodies can be difficult to diagnose and should be considered in the differential diagnosis of unexplained pain, even in the absence of recalled trauma. We present the case of a 22-year-old male with a painful left heel. The patient did not recall a specific traumatic incident, and there were no clinical signs of trauma or infection. Plain films of the foot were nonrevealing, but magnetic resonance imaging revealed a sinus tract and left calcaneal defect. A biopsy of the calcaneal defect revealed viable woody material embedded and partially integrated with the surrounding bone. Postoperatively the patient's pain completely resolved. This case illustrates the importance of radiopathologic pursuit of an etiology of unexplained foot pain in an otherwise healthy person.
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Affiliation(s)
- Marc D. Jones
- Department of Surgery, Madigan Army Medical Center, Tacoma, WA. Dr. Jones is now with Mann-Grandstaff VA Medical Center, Spokane, WA
| | - Kerry J. Sweet
- Department of Surgery, Madigan Army Medical Center, Tacoma, WA. Dr. Sweet is now with VA Puget Sound Health Care System, American Lake Division, Tacoma, WA
| | - Zachary S. Hoffer
- Pathology and Laboratory Services, Madigan Army Medical Center, Tacoma, WA
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Abstract
Puncture wounds of the foot are a common injury, and infection associated with these injuries may result in considerable morbidity. The pathophysiology and management of a puncture wound is dependent on the material that punctures the foot, the location and depth of the wound, time to presentation, footwear, and underlying health status of the patient. Puncture wounds should not be treated lightly, so accurate diagnosis, assessment, and treatment are paramount. Early incision and drainage, vaccination, and the use of proper antibiotics can lead to positive outcomes and prevent limb-threatening circumstances.
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Affiliation(s)
- Ronald Belin
- Broadlawns Medical Center, 1801 Hickman Road, Des Moines, IA 50314, USA.
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Pattamapaspong N, Srisuwan T, Sivasomboon C, Nasuto M, Suwannahoy P, Settakorn J, Kraisarin J, Guglielmi G. Accuracy of radiography, computed tomography and magnetic resonance imaging in diagnosing foreign bodies in the foot. Radiol Med 2012; 118:303-10. [DOI: 10.1007/s11547-012-0844-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Accepted: 11/18/2011] [Indexed: 11/28/2022]
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