Soft Tissue Foreign Body

GENERAL INFORMATION:

What is a soft tissue foreign body?

• A soft tissue foreign (FOHR-en) body is an object under your skin that should not be there. Your soft tissue includes things such as your skin, muscles, and fat. Common soft tissue foreign bodies are wood splinters, slivers of metal or glass, and gravel. A foreign body may also be from a more serious injury, such as a bullet from a gunshot. A soft tissue foreign body may be deep under your skin or it may be close to the top of the skin. It may be hidden under the skin, or may have part of it sticking above the skin's surface (such as a fishhook).
  
  
• Some objects may come out of the skin on their own over time. Some foreign bodies may cause an infection (in-FEK-shun) and need to be removed right away. Some objects may be safely left in the tissue. In some cases, it may be more harmful to remove the object than it is to leave it.

What are the signs and symptoms of a soft tissue foreign body?

• You may be able to see the opening where the object entered the skin. This opening may be a cut, gash, or a puncture wound. You may feel a foreign object under your skin. You may even be able to see it. You may feel sharp pain if the wound area is touched. Sometimes, you may have a foreign object under your skin and not even know it. For example, a sharp object (such as a needle or toothpick) may make just a tiny hole as it enters the skin. You may not have even felt the object go into your skin.
  
  
• Your skin may hurt, bleed, bruise, or swell after the object enters your skin. Your wound may have edges that are slightly red and sore for a while. This redness is your body's reaction to the foreign object. The reaction is not a problem if it is minor and it goes away in a few days. Tell your caregiver if your wound has redness or soreness that gets worse instead of better. This may mean you have a more serious reaction, or an infection.

How will my injury be treated? Caregivers will first work to control the bleeding if your wound is bleeding a lot. You may need your wound cleaned out with germ-free liquid. This helps to remove dirt and other small objects, and decreases the chance of infection. Your caregiver may need to make an incision (cut) in your skin to remove the object. You may need stitches (sutures) or other treatments to close the wound. Some foreign body wounds need special care. For example, wounds caused by fish or marine life may need special medicines. Antibiotics (an-ti-bi-AH-tiks) are not needed for most wounds. You may need antibiotics if your wound has a high risk of infection. You may need to see special caregivers if the foreign body has hurt bone, nerves, or blood vessels in your body.

How will my caregiver find the foreign body? Finding the object may depend on how you got it and the type of wound you have. For example, it may be easier to find foreign objects in an open cut than in a small puncture wound. Your caregiver may find some objects now, and some weeks or even months later. Your caregiver may need to check your wound for foreign objects in a variety of ways.

• Probing the wound: Your caregiver may press on the edges of your wound to feel for a foreign object. If the object is not seen easily, your caregiver may have to explore the wound to find it. You may need to have your skin numbed with medicine if your caregiver needs to explore (probe) the wound. This numbing medicine may decrease the discomfort you feel. The wound may also need to be opened further by your caregiver. If the foreign body is something hard to see, a small block of tissue may need to be cut out. Tell your caregiver if you are allergic to lidocaine, or to any other dental or numbing medicine. Tell your caregiver if you are allergic to any antibiotics, iodine, or latex (rubber).
  
  
• Other tests: Some objects (such as metal, gravel, and glass) may be found by taking x-ray pictures. You may need more tests, depending on what caused you to have a foreign body. For example, your caregiver may do more tests if you have many wounds from a car accident. These tests may help your caregiver find deep or hidden foreign objects in other places in your body. Tests may include an ultrasound, a MRI, or a CT ("cat") scan. These tests allow your caregivers to see detailed pictures of your soft tissue. It may be important for your caregivers to find out exactly where the object is before they remove it. Ask your caregiver for more information about any tests or treatments that you may need.

How will my caregiver decide if the object should be removed or not? Some things, like small splinters just underneath the skin, can be removed easily. Other foreign bodies may not be so simple. Your caregiver will need to think about the benefits of removing the object, and the risks. Your caregiver will consider the type of injury you have, and what the object is made of. The decision may depend on where the object is, and what tissues may be damaged (hurt) if it was removed. Your caregiver may not be able to remove the object if you cannot hold still during treatment.

• Leaving the foreign body in: If an object is very deep, it may cause more damage to remove it than to leave it there. For example, removing some objects may cause damage to an organ or blood vessels. Some objects may splinter (break into even smaller pieces) when they are removed, so leaving it may be better. Things such as glass, metal, and plastic that are deep in the tissue can sometimes be left in place safely. Your caregiver can remove the object at a later time if it starts to cause problems. Some foreign objects that will dissolve (break up) and be absorbed by the body may be left in place. Some objects left in place may harmlessly work their way out of the body months or years later.
  
  
• Taking the foreign body out: Foreign bodies that are dirty may increase your risk of having an infection. Some other objects, such as wood, may cause a bad reaction if left in the skin. These objects will be removed by your caregiver if it is possible and safe to do so.

How do I know if I need a tetanus shot? Tetanus infection, or "lockjaw," can happen after any break in your skin. Tetanus is very serious, and may even kill you. It is important for adults to get a tetanus shot at least every 10 years. After an injury, you may need a tetanus shot if it has been longer than five years since your last one. Your caregiver may decide if you need a tetanus shot based on your wound. Wounds at high risk for tetanus infection include any wound that may have dirt or saliva (spit) in it. Many puncture wounds also have a high risk for tetanus infection. When needed, tetanus shots should be given as soon as possible (within 72 hours of the injury). Ask your caregiver for more information about how often children need tetanus shots.

What are the risks of leaving the foreign body in place? Leaving the object in your soft tissue may be safer than removing it. However, there are still risks when leaving the object in place. Problems that may happen when an object is left in your body may include:

• Reaction: A reaction is not an infection. A reaction happens when the object causes irritation in the soft tissue. Objects like metal have a low risk of causing a reaction. Other objects are more likely to cause a reaction, such as thorns from a plant. Signs of a reaction include increased redness and tenderness over the area. Your caregiver may leave an object in place, and later need to take it out because of a reaction.
  
  
• Infection: Your risk of infection is greatly decreased if you see a caregiver right away after your injury. Even wounds that are cared for properly may still become infected. Signs that your wound may be infected include:
  
  
  • Increased warmth to the area.
    
    
  • Redness or swelling to the area that gets worse instead of better. You may have a red streak coming from the wound.
    
    
  • Pain in the area that gets worse instead of better.
    
    
  • You have pus or bad-smelling drainage from the wound. Pus is a fluid that sometimes drains from a wound that is infected. Pus may be white, yellow, green, or brown.
  
  
• Damage to nearby tissue: Over time, the object may damage tissue, nerves, or blood vessels around it. This can happen even years after the object entered the body. The object may block blood flow through a blood vessel, or even cause a blood clot. The risk of this happening depends on where the object is and what it is made of. Your caregiver will consider the risk of tissue damage when deciding whether to leave the object or remove it.
  
  
• Migration: Over time, a foreign object may migrate (travel) to a different area of the body. This is often harmless, but can sometimes be dangerous. For example, an object that enters a blood vessel and travels elsewhere can be serious, even life-threatening. Your caregiver will consider the risk of migration when deciding whether to leave the object in place.

Should I be worried about lead poisoning?

• From a pencil: A common soft tissue foreign body happens when the tip of a pencil breaks off under the skin. Pencils now have a "lead" that is actually made of a material called graphite. Graphite is not a harmful material. However, pencil graphite may cause a permanent (life-long) darkening of the tissue around the wound.
  
  
• From a bullet: Bullets that are deep in the tissue may need to be left in place. Very rarely, this has caused lead poisoning years later. This has happened most often when the bullet was left in the fluid of a joint. Most of the time, the danger of removing the bullet is much greater than the risk of lead poisoning. Some bullets are made of lead, while others are not. Talk with your caregiver if you have concerns about a bullet being left in your body.

What are some other risks of having a soft tissue foreign body?

• Some foreign objects may have passed through clothing before entering your skin. For example, stepping on a nail may cause it to pass through your sock before entering your foot. This may have caused small threads or bits of clothing to be pushed under your skin. Bits of clothing in a wound increases your risk of getting an infection. The risk infection may be even more serious if the foreign body went through the rubber sole of a shoe.
  
  
• Your risk of having serious problems is increased if you did not see a caregiver right after your injury. Even with the best care, you may still have problems with your wound, such as infection. There is a risk that some foreign objects will not be found.
  
  
• Some objects that would be harmless to healthy people may be dangerous to others. For example, a small splinter in the foot may cause a serious infection if you have diabetes.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

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