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Soft tissue foreign bodies may be encountered when managing new wounds or evaluating complications of old wounds. This chapter discusses the effects of foreign bodies on soft tissue and methods of detecting and removing them.

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When evaluating fresh wounds, methodically search for contamination by foreign material. If a foreign body is discovered within a wound cavity or deeply embedded in tissue, the clinician should decide if removal of the material is urgent, can be delayed, or is even necessary. The decision to remove foreign bodies located below the dermal layer of skin depends on the size, location, composition, accessibility, and anticipated mechanical and inflammatory effects of the object. Many foreign bodies should be removed in the ED. For example, all foreign material within the cavities of fresh lacerations should be irrigated away, debrided, or extracted with instruments. Occasionally, patients with subcutaneous foreign bodies should be referred to appropriate physicians for delayed removal.

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Most, but not all, foreign bodies are detectable during clinical examination.1–3 Various imaging studies can be used to evaluate wounds when nothing is found during exploration, but the possibility of a concealed object exists.4 However, some foreign bodies may be invisible to radiographic or sonographic study, so patients should be informed of this possibility and receive appropriate discharge instructions.

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Transient inflammation is an integral part of normal wound healing. A small amount of foreign debris in a wound provokes an inflammatory response in an effort to eliminate or contain the invader. When large quantities of devitalized tissue, foreign debris, bacteria, or other irritants are present within a wound, this protective response intensifies. Excessive or prolonged inflammation may delay wound healing or destroy surrounding soft tissue and bone, producing periosteal reactions, osteolytic lesions, synovitis, and arthritis. If the body fails to dissolve or extrude foreign material, it will become encapsulated within a fibrous capsule. Once a retained foreign body is encapsulated, inflammation subsides.

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The type, timing, and intensity of an inflammatory reaction are determined primarily by the chemical composition and physical form of the foreign object. Material that is inert—such as glass, metal, or plastic—may not elicit any abnormal tissue response. Objects with smooth, nonporous surfaces produce less inflammation and fibrosis than those with rough surfaces. Most metals are inert, but those that oxidize will cause mild to moderate inflammation. Earrings with studs dipped in gold paint cause earlobe swelling and inflammation when the paint flakes off. Vegetative foreign bodies, such as wood, thorns, and spines, trigger the most severe inflammatory reactions. Sea urchin spines, other marine foreign bodies, and hair may cause chronic inflammation with granuloma formation.

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In some cases, inflammation is caused by a local toxic reaction. For example, blackthorns contain an alkaloid that produces intense inflammation. The oils and resins in redwood and cedar splinters also cause considerable inflammation. Sea urchin spines and catfish spines contain venom that causes severe burning pain at the puncture site ...

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