Ized on ultrasound but small pieces may frequently be

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ized on ultrasound, but small pieces may frequently be missed using this technique. Procedure Once the foreign body is localized, several techniques can be employed to remove it. One simple method is to guide a needle or wire to the foreign body Figure 16.16 Alligator forceps. 310 Procedural ultrasound Ultrasound for procedure guidance
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using ultrasound, and then dissect to the foreign body using the metal guide. Kopans wires, often used for radiographic localization of breast masses prior to dissection, have been used by some operators. This technique can be useful when guiding the dissection for a consultant who will then use standard techniques. Alternatively, many foreign bodies can be directly removed using ultra- sound to guide the entire procedure. First, localize the long axis of the foreign body (splinters, toothpicks, and many metal foreign bodies are quite linear). Keeping the long axis of the foreign body centered on the screen, guide a needle with anesthetic solution to the foreign body using the same long-axis Figure 16.17 Transverse images of plastic, wood, and metal foreign bodies (left to right) are demonstrated. Note the shadows deep to each structure. Figure 16.18 A wooden foreign body is demonstrated in the long axis. Procedural ultrasound 311 Ultrasound for procedure guidance
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approach described in Chapter 15 . It is often easiest to enter the needle into the skin at the puncture point for the foreign body. Once contact with the foreign body is felt at the end of the needle (sometimes a tap can be heard as well), inject a generous amount of anesthetic at the site of contact ( Figure 16.20 ). In most cases, the solution will track around the entire foreign body, with three consequences. First, the foreign body will be better visualized as it is now surrounded by a rim of anechoic fluid. Second, the area will be well Figure 16.19 Metal foreign body (arrow) in soft tissue over zygoma. Figure 16.20 The needle (left side of screen) approaches the wooden foreign body. 312 Procedural ultrasound Ultrasound for procedure guidance
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anesthetized without the need for multiple injections. Third, the foreign body will often be “loosened” a bit by the extra fluid. Now that a track of anesthetic has been deployed from the surface of the skin down to the foreign body, the object can be removed under direct visualization. Make a small nick in the skin (or use the entry point for the foreign body) at the site of desired entry. Using the same long-axis technique, use an alligator forceps to follow the same path the anesthetic needle just took. Be sure to keep the forceps in the plane of the ultrasound beam. If the forceps veers off course, then back up toward the skin surface and redirect into the plane. Once contact with the foreign body is felt at the end of the forceps (sometimes a tap can be heard as well), open the jaws slightly to grasp the end of the object. The object can then be withdrawn along the previously anesthetized track.
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