Surgical/Plastics

Question 1

What are the different approaches to fish hook removal?

Answer 1

Push through
- Anesthetise the skin where the hook will come out
- Use forceps (ie hemostat) and push the hook through
- Cut off the barbed end (if one barb) and then pull it back
- Or if multiple barbs then dont cut off the barb, but grasp it and pull it through
- Wound care, sutures, ADT/ABx as needed

String method
- Tie string around hook
- Push down on back end of hook to help dislodge barb
- Quick pull on string to dislodge barb

Needle cover
- Lots of local
- Advance 18g or larger needle in parallel to the hook aimin for the barb
- Push hook forward to disengage the barb and then push needle bevel over the end of the barb
- Carefully pull back with the barb protected by the needle bevel

Question 2

What are the Indications, contraindications and complications of re-implanting amputated areas?

Answer 2

Indications
- Young and stable
- Multiple digits and/or thumb
- Upper extremity (children)
- Little surrounding damage

Absolute Contraindications
- Associated life threats
- Sever crush injuries
- Can’t withstand prolonged surgery

Relative Contraindications
- Single digit (except thumb)
- Avulsion injury
- Warm ischaemia >12hrs
- Gross contamination
- Prior injury/surgery to affected part
- Lower extremity
- Emotionally/Mentally unstable

Complications
- Infection
- poor function