Trick of the Trade: Fishhook Removal Techniques

Penetrating fishhook injuries can be a common occurrence during the warm weather months. Initially, it is important to evaluate what type of fishhook was being used. How many and where are the barbs? What shape is it (treble hook, single hook)? The physical examination requires a thorough neurovascular exam and, if penetration depth is difficult to assess, radiographs should be utilized for further evaluation.

What approach do you use to remove these barbed fishhooks?

Special Complicated Scenarios

Though most fishhooks get caught in the superficial soft tissue of the upper extremity or face, occasionally they can get caught in the orbit itself^1,2 or have joint/tendon involvement. If this is the case, an ophthalmology or orthopedic consult is warranted, respectively, prior to fishhook extraction.

The majority of fishhook cases, however, are uncomplicated. All you need to remember are these few techniques to make removal simple.^3–5

Approach 1: Push-Through Technique

When and Why?

• This technique is preferred for fishhooks with the point already near the surface of the skin or smaller fishhooks.
• It causes little additional soft tissue injury and has a high success rate.
• Helpful with fishhooks that have multiple barbs.

Equipment

• Hemostat
• Wire cutter or scissors
• Anesthetic (optional)

Technique

1. Anesthetize the surface of the skin where the fishhook will come out (optional if already very close to the surface)
2. Using the hemostats, grab the exposed end of the fishhook and advance the fishhook until the barbed tip is outside the skin.
3. If ONE barb, use the wire cutters to cut the hook proximal to the barb. Back the hook out of the skin (see image series below).
4. If MULTIPLE barbs, cut the proximal part of the hook (non-barb end) flush with the skin. Use the hemostats, which are still grabbing the distal portion of the hook, to pull the entire hook through the newly created hole.

Typically the wound will not need suture repair as the wounds will be small.

Approach 2: String Technique

When and Why?

• Helpful for quick removals and requires few resources
• Can be performed in the field
• Careful with removal as the hook may fly off in an unpredictable fashion
• Should not be used on parts of the body that are free-floating, such as the earlobe

Equipment

• String or suture

Technique

1. A string or suture should be wrapped/tied around the midpoint of the bend of the hook.
2. Exert downward pressure on the shank of the fishhook to dislodge the barb as much as possible from the local soft tissue.
3. Using a quick motion, pull parallel to the barbed tip with the suture.
4. Be careful as the fishhook will be propelled out very rapidly and can cause additional injury.

Approach 3: Needle Cover

When and Why?

• Helpful for large fishhooks with larger barbs
• Requires local anesthesia

Equipment

• 18 gauge needle
• Local anesthesia

Technique

1. Administer local anesthesia around the entrance of the fishhook in the skin.
2. Slowly advance the 18-gauge needle parallel to the fishhook so that the bevel is facing the inside curve of the fishhook.
3. Advance the fishhook to disengage the barb.
4. Twist and pull the fishhook to engage the barb into the lumen of the needle.
5. Carefully retract the fishhook and needle together through the tract made by the fishhook.

After Removal Care

• Carefully examine for any retained foreign bodies.
• Thoroughly irrigate the wound.
• Apply triple antibiotic ointment and a wound dressing.
  • Currently there is no evidence for systemic antibiotic therapy.
  • Consider systemic antibiotics in those who may be immunocompromised or if the fishhook had penetrated more than just soft tissue (e.g. tendon or cartilage)
• Administer a tetanus immunization, if none within 5 years.
• Arrange follow-up wound care, if there are concerns for infection.

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