Sometimes, a fish hook ends up embedded in the skin, and the barb prevents easy removal.   (tip - one way to avoid this issue is to fish with barbless hooks, or hooks that have mashed barbs).

If you need Medical Attention:
Bull Shoals: Combs Clinic 870.445.3296 / 870.506.0033.  505 Hillcrest St, Bull Shoals, AR 72619
Lakeview: David Fulghum (nurse practitioner) 870.656-9160.
Mtn Home: Med Express, 870.425.0176.  8am-8pm.  EKG, X-Rays;
     Basic office visit: $119 incl follow-up visit within 10 days (if for same diagnosis).
     305 Highway 62 East;   Mountain Home, AR 72653;
Mtn Home: Emergency Room, Baxter Regional Medical Center 870.425.1000.

Do-It-Yourself Fishhook Removal:  While serious injuries are uncommon, penetrating tissue trauma involving fishhooks frequently occurs.  All fishhook injuries require careful evaluation of surrounding tissue before attempting removal. Ocular involvement should prompt immediate referral to an ophthalmologist.  The choice of the method for fishhook removal depends on the type of fishhook embedded, the location of the injury and the depth of tissue penetration. Occasionally, more than one removal technique may be required for removal of the fishhook. The retrograde technique is the simplest but least successful removal method, while the traditional advance and cut method is most effective for removing fishhooks that are embedded close to the skin surface. The advance and cut technique is almost always successful, even for removal of large fishhooks. The string-yank method can be used in the field and can often be performed without anesthesia. Wound care following successful removal involves extraction of foreign bodies from the wound and the application of a simple dressing. Prophylactic antibiotics are generally not indicated. Tetanus status should be assessed and toxoid administered if needed.

Angling is a popular sport worldwide, and fishhook injuries are common in recreational and commercial fishing settings. Persons with fishhook injuries may not present to the office or emergency department because removal of embedded fishhooks can usually be accomplished in the field. However, some embedded fishhooks cannot be removed in this manner and require evaluation of the injury and exploration of the wound for the presence of a foreign body. Four techniques for removing embedded fishhooks are described in this article

Credit: MATTHEW GAMMONS, M.D., and EDWARD JACKSON, M.D., Michigan State University College of Human Medicine, East Lansing, Michigan    Am Fam Physician. 2001 Jun 1;63(11):2231-2237.

 

Patient Evaluation 

Hook Types - (A) Simple-single barbed fishhook. (B) Multiple-barbed fishhook. (C) Treble fishhook.

Principles of RemovalFour primary techniques have been described for the removal of fishhooks: retrograde, string-yank, needle cover, and advance and cut. Each method and some modifications to these techniques are described in detail in this article. The method selected to remove anembedded fishhook is usually based on the judgment of the physician, the anatomic location of the injury and the type of fishhook.

Most embedded fishhooks can be removed with minimal surgical intervention. Generally, the retrograde and string-yank methods should be the first techniques attempted because they result in the least amount of tissue trauma. The more invasive procedures, such as the needle cover and advance and cut techniques, are reserved for more difficult fishhook removal.7 Sometimes multiple techniques must be attempted before the fishhook is successfully removed.

Most removal methods require the administration of a local anesthetic or a nerve block. Superficially embedded hooks may not require anesthesia if they can be backed out or removed easily by the string-yank method.

Local care typically involves cleaning the site with povidone-iodine or hexachloro-phene solution before attempting removal of the fishhook. Saline irrigation may be required. Fishhooks with more than one point (i.e., treble fishhooks) should have the uninvolved points taped or cut to avoid imbedding these during the removal procedure. A local anesthesia should be administered before attempting removal of any barbed fishhook. All items attached to the hook (i.e., fish line, bait and the body of the lure itself) should be removed. The physician and bystanders should take care not to be struck by the hook on removal. Eye protection should be worn, especially when performing the string-yank method.

Retrograde Technique - Retrograde technique is the simplest of the removal techniques but has the lowest success rate. It works well for barbless and superficially embedded hooks. Downward pressure is applied to the shank of the hook. This maneuver helps rotate the hook deeper and disengage the barb, if present, from the tissue. The hook can then be backed out of the skin along the path of entry. Any resistance or catching of the barb during the procedure should alert the physician to stop and consider other removal methods.

 Retrograde technique. Downward pressure is applied to the shank of the fishhook while it is backed out along the point of entry.

String-Yank Technique -  It may be used to remove any size fishhook but generally works best when removing fishhooks of small and medium size. This technique also works well for deeply embedded fishhooks, but cannot be performed on parts of the body that are not fixed (e.g., earlobe).  Physicians should be familiar with the concepts of this method because improper technique could cause further tissue damage.  A string, such as fishing line, umbilical tape or silk suture, should be wrapped around the midpoint of the bend in the fishhook with the free ends of the string held tightly. A better grip on the string can be achieved by wrapping the ends around a tongue depressor. The involved skin area should be well stabilized against a flat surface as the shank of the fishhook is depressed against the skin. Continue to depress the eye and/or distal portion of the shank of the hook, taking care to keep the shank parallel to the underlying skin. A firm, quick jerk is then applied parallel to the shank while continuing to exert pressure on the eye of the fishhook. The fishhook may come out with significant velocity so the physician and bystanders should remain out of the line of flight.  String-yank method. (A) Wrap a string around the midpoint of the bend in the fishhook. (B) Depress the shank of the fishhook against the skin. (C) Firmly and quickly pull on the string while continuing to apply pressure to the shank.

Needle Cover -  requires dexterity on the part of the physician. It works well for the removal of large hooks with single barbs but is most effective when the point of the fishhook is superficially embedded and can be easily covered by the needle. After skin preparation and administration of local anesthesia, an 18-gauge or larger needle is advanced along the entrance wound of the fishhook . The direction of insertion should be parallel to the shank. The bevel should point toward the inside of the curve of the fishhook, enabling the needle opening to engage the barb. It is important to have the bevel pointed in the correct direction so that the longer edge of the needle matches the angle of the fishhook point. The physician should advance the fishhook to disengage the barb, then pull and twist it so that the point enters the lumen of the needle. The physician can then back out the fishhook (the same way as in the retrograde technique), taking care to move the needle along the track with the fishhook.   Needle cover method. (A) Advance an 18-gauge or larger-gauge needle along the fishhook until the needle opening covers the point. (B) The fishhook and needle are then removed at the same time.  A modification of this technique involves sliding a no. 11 scalpel blade along the wound to the point of the fishhook. The fishhook may then be backed out because the incision allows room for the point. This modification may also be used in combination with the needle cover technique for more difficult fishhook injuries

Advance and Cut -  One advantage of this traditional method of fishhook removal is that it is almost always successful, even when removing larger fishhooks; however, additional trauma to the surrounding tissue is a disadvantage. The advance and cut technique is most effective when the point of the fishhook is located near the surface of the skin.  It involves two methods of removal: one for single-point fishhooks and one for multiple-barbed fishhooks. Infiltration with a local anesthetic is performed over the area where the fishhook has penetrated the skin. Using pliers or needle drivers, the point of the fishhook (including the entire barb) is advanced through the skin. The point is then cut free with the pliers or another cutting tool, allowing the rest of the fishhook to be backed out with little resistance.  Advance and cut method: single-barbed fishhook. (A) The fishhook is advanced through the skin. (B)The barb is then cut off and (C) the remaining hook is backed out through the entry wound.

For multiple-barbed fishhooks, the area should be anesthetized and the fishhook advanced. Instead of removing the point, the eye of the fishhook is removed. The physician can then continue to pull the fishhook in the same direction as the point was advanced.

Post Removal Wound Care  After removal of the fishhook, the wound should be explored for possible foreign bodies (e.g., bait). It is usually sufficient to leave the wound open, then apply an antibiotic ointment and a simple dressing. Tetanus toxoid should be administered to persons for whom more than five years has elapsed since their last tetanus booster. Well-conducted, controlled studies do not exist that support the need for systemic antibiotics in these cases; they are generally not indicated. Prophylactic antibiotic therapy may be considered for persons who are immunosuppressed or have poor wound healing (e.g., patients with diabetes mellitus or peripheral vascular disease). Prophylactic antibiotic therapy may also be considered for deeper wounds that involve the tendons, cartilage or bone. Follow-up care should be performed to ensure adequate healing and the absence of infection.