Journal of Plastic, Reconstructive & Aesthetic Surgery (2013) 67, e97ee98
CORRESPONDENCE AND COMMUNICATION Removal of a metallic foreign body from the abdominal wall using an orientable magnetic locator Dear Sir, The surgical extraction of metal objects can often be frustrating and time consuming. Despite the use of preoperative radiographs and intraoperative fluoroscopy, locating these metal objects can be extremely difficult,1 due to their small size and the degree of penetration. In such cases, the need for major surgical dissection and increased exposure to anaesthesia can lead to increased morbidity. A magnet could help locate the metal object more quickly, potentially reducing these risks. Accordingly, this paper describes the use of a magnetic locator, a device to indicate the location of a metallic object, functioning in a similar way to a compass (Figure 1). The case in question concerns a female patient, aged 19 years, with no significant clinical history, although a point of interest in the family background is that her father is a carpenter. She attended for treatment complaining of discomfort for several months in the left hypochondrium near the rib cage. No history of trauma was recalled. An abdominal radiograph was performed, revealing a foreign body in the affected area; subsequent TAC confirmed the body was located in the abdominal wall. Clinical examination revealed it to be metallic and subject to magnetism. A surgical intervention was performed (Figure 2), using a magnetic locator to determine the site of the foreign body, and a metal fragment, apparently from a pin, was extracted. In a second exploration of the area with the magnetic locator, activity was detected and a second fragment extracted. Subsequent exploration revealed no further magnetic activity, and the presence of more fragments was discounted. The postoperative evolution was satisfactory, the patient was discharged from hospital and the follow-up radiograph confirmed the complete removal of the foreign body.
Foreign bodies become embedded in soft tissue relatively frequently and on many occasions their removal poses a considerable challenge due to the difficulty of locating them. Various methods can be used to detect and locate these foreign bodies. Conventional two-plane radiography is capable of revealing metal objects fairly accurately, while CT scanning is even better for pinpointing the location of the fragment prior to the operation.2 An X-ray intensifier is routinely used during the operation and this is usually the technique of choice when a foreign body is difficult to find; however, it presents the disadvantage that the medical personnel and the patient are exposed to radiation. Ultrasound is a sensitive, specific means of detecting foreign bodies in soft tissues.2 The literature in this respect contains reports of the use of a magnet inserted into a gastric tube in order to remove ingested metal objects.3 The use of magnets has also been described in plastic surgery, ophthalmology, and emergency medicine for locating cutaneous and subcutaneous foreign bodies.4 In the case described here, our method was based on the approach in which an injection port detector (Centerscope ) can be applied to locate the metal component of breast
Figure 1 Use of the locator: as the metal object is approached, the magnet is drawn toward it.
1748-6815/$ - see front matter ª 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.bjps.2013.10.019
e98
Correspondence and communication removal, as occurred in the clinical case reported. Among other advantages of using a magnet to locate the foreign body, with respect to the use of radiological exploration, is that the patient is not exposed to radiation, it is safe and much less costly. A magnet may be used even when the foreign body is palpable, as sometimes these bodies cannot be located after the anaesthetic infiltration, due to oedema.5 In summary, we believe that in cases of metallic objects embedded in soft tissues, a magnet can usefully be applied for their location and extraction, this method being safe and inexpensive. The use of a device incorporating a magnet, as described in this case, facilitates the localization of such objects, providing a three-dimensional spatial orientation thanks to its capacity to identify the area of magnetic attraction. Thus, a solution is offered for complex cases of small metallic objects that are deeply embedded and difficult to locate.
Conflict of interest/funding None.
References
Figure 2 Location of area of greatest magnetism, coinciding with the perpendicular orientation of the magnetic locator. The area is marked and with the help of the magnet the location of the foreign body within the subcutaneous tissues is determined, so that it can be removed.
tissue expanders. Thus, we used a powerful magnet, capable of pointing in the direction of the metal object, like a pendulum, such that when it is in the neutral position, it will be located immediately above the object. The device is simple and inexpensive, consisting of a magnet in contact with the head of a pin, which in turn is in contact with the head of a nail, thus creating a magnetic field that holds the three elements together. At the point of union between the pin and the nail, there is full mobility, like a universal joint, and so the pin can point in any direction toward an object attracted by the magnet. This modification was made, and the use of an injection port detector was ruled out because it would have been too large to be passed through the incision, and therefore would be of no assistance during the surgical procedure. The magnetic locator not only helps locate metal objects, for rapid, straightforward removal, but also ensures that no fragmented parts of the object remain after its
1. Giu H, Yang H, Shen S, Xu B, Zhang S, Bautista J. Image-guided surgical navigation for removal of foreign bodies in the deep maxillofacial region. J Oral Maxillofac Surg 2013;71(9): 1563e71. 2. Chen Y, Zeng QL, He XF, Lu W, Mei QL, Li YH. Removal of metalic foreign bodies in the soft tissue under fluoroscopy: 10 years of experiences. J South Med Univ 2009;29(12):2504e5. 3. Brandt LJ. Endoscopic ferromagnetic object retrieval by use of a simple magnet. Gastroint Endosc 2012;76(3):667. 4. Dolderer JH, Kelly JL, Morrison WA, Penington AJ. Foreign-body retrieval using a rare earth magnet. Plast Reconstr Surg 2004; 113(6):1869e70. 5. C ¸ akır B, Akan M, Yıldırım S, Ako ¨z T. Localization and removal of ferromagnetic foreign bodies by magnet. Ann Plast Surg 2002; 49(5):541e4.
F.J. Pe ´rez Lara Service of Surgery, Hospital de Antequera, Ma´laga, Spain E-mail address: [email protected] A. Ferrer Berges Service of Plastic Reconstructive and Cosmetic Surgery, Hospital Regional Carlos Haya, Ma´laga, Spain H. Oliva Mun ˜oz Service of Surgery, Hospital de Antequera, Ma´laga, Spain
31 August 2013
CORRESPONDENCE AND COMMUNICATION Removal of a metallic foreign body from the abdominal wall using an orientable magnetic locator Dear Sir, The surgical extraction of metal objects can often be frustrating and time consuming. Despite the use of preoperative radiographs and intraoperative fluoroscopy, locating these metal objects can be extremely difficult,1 due to their small size and the degree of penetration. In such cases, the need for major surgical dissection and increased exposure to anaesthesia can lead to increased morbidity. A magnet could help locate the metal object more quickly, potentially reducing these risks. Accordingly, this paper describes the use of a magnetic locator, a device to indicate the location of a metallic object, functioning in a similar way to a compass (Figure 1). The case in question concerns a female patient, aged 19 years, with no significant clinical history, although a point of interest in the family background is that her father is a carpenter. She attended for treatment complaining of discomfort for several months in the left hypochondrium near the rib cage. No history of trauma was recalled. An abdominal radiograph was performed, revealing a foreign body in the affected area; subsequent TAC confirmed the body was located in the abdominal wall. Clinical examination revealed it to be metallic and subject to magnetism. A surgical intervention was performed (Figure 2), using a magnetic locator to determine the site of the foreign body, and a metal fragment, apparently from a pin, was extracted. In a second exploration of the area with the magnetic locator, activity was detected and a second fragment extracted. Subsequent exploration revealed no further magnetic activity, and the presence of more fragments was discounted. The postoperative evolution was satisfactory, the patient was discharged from hospital and the follow-up radiograph confirmed the complete removal of the foreign body.
Foreign bodies become embedded in soft tissue relatively frequently and on many occasions their removal poses a considerable challenge due to the difficulty of locating them. Various methods can be used to detect and locate these foreign bodies. Conventional two-plane radiography is capable of revealing metal objects fairly accurately, while CT scanning is even better for pinpointing the location of the fragment prior to the operation.2 An X-ray intensifier is routinely used during the operation and this is usually the technique of choice when a foreign body is difficult to find; however, it presents the disadvantage that the medical personnel and the patient are exposed to radiation. Ultrasound is a sensitive, specific means of detecting foreign bodies in soft tissues.2 The literature in this respect contains reports of the use of a magnet inserted into a gastric tube in order to remove ingested metal objects.3 The use of magnets has also been described in plastic surgery, ophthalmology, and emergency medicine for locating cutaneous and subcutaneous foreign bodies.4 In the case described here, our method was based on the approach in which an injection port detector (Centerscope ) can be applied to locate the metal component of breast
Figure 1 Use of the locator: as the metal object is approached, the magnet is drawn toward it.
1748-6815/$ - see front matter ª 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.bjps.2013.10.019
e98
Correspondence and communication removal, as occurred in the clinical case reported. Among other advantages of using a magnet to locate the foreign body, with respect to the use of radiological exploration, is that the patient is not exposed to radiation, it is safe and much less costly. A magnet may be used even when the foreign body is palpable, as sometimes these bodies cannot be located after the anaesthetic infiltration, due to oedema.5 In summary, we believe that in cases of metallic objects embedded in soft tissues, a magnet can usefully be applied for their location and extraction, this method being safe and inexpensive. The use of a device incorporating a magnet, as described in this case, facilitates the localization of such objects, providing a three-dimensional spatial orientation thanks to its capacity to identify the area of magnetic attraction. Thus, a solution is offered for complex cases of small metallic objects that are deeply embedded and difficult to locate.
Conflict of interest/funding None.
References
Figure 2 Location of area of greatest magnetism, coinciding with the perpendicular orientation of the magnetic locator. The area is marked and with the help of the magnet the location of the foreign body within the subcutaneous tissues is determined, so that it can be removed.
tissue expanders. Thus, we used a powerful magnet, capable of pointing in the direction of the metal object, like a pendulum, such that when it is in the neutral position, it will be located immediately above the object. The device is simple and inexpensive, consisting of a magnet in contact with the head of a pin, which in turn is in contact with the head of a nail, thus creating a magnetic field that holds the three elements together. At the point of union between the pin and the nail, there is full mobility, like a universal joint, and so the pin can point in any direction toward an object attracted by the magnet. This modification was made, and the use of an injection port detector was ruled out because it would have been too large to be passed through the incision, and therefore would be of no assistance during the surgical procedure. The magnetic locator not only helps locate metal objects, for rapid, straightforward removal, but also ensures that no fragmented parts of the object remain after its
1. Giu H, Yang H, Shen S, Xu B, Zhang S, Bautista J. Image-guided surgical navigation for removal of foreign bodies in the deep maxillofacial region. J Oral Maxillofac Surg 2013;71(9): 1563e71. 2. Chen Y, Zeng QL, He XF, Lu W, Mei QL, Li YH. Removal of metalic foreign bodies in the soft tissue under fluoroscopy: 10 years of experiences. J South Med Univ 2009;29(12):2504e5. 3. Brandt LJ. Endoscopic ferromagnetic object retrieval by use of a simple magnet. Gastroint Endosc 2012;76(3):667. 4. Dolderer JH, Kelly JL, Morrison WA, Penington AJ. Foreign-body retrieval using a rare earth magnet. Plast Reconstr Surg 2004; 113(6):1869e70. 5. C ¸ akır B, Akan M, Yıldırım S, Ako ¨z T. Localization and removal of ferromagnetic foreign bodies by magnet. Ann Plast Surg 2002; 49(5):541e4.
F.J. Pe ´rez Lara Service of Surgery, Hospital de Antequera, Ma´laga, Spain E-mail address: [email protected] A. Ferrer Berges Service of Plastic Reconstructive and Cosmetic Surgery, Hospital Regional Carlos Haya, Ma´laga, Spain H. Oliva Mun ˜oz Service of Surgery, Hospital de Antequera, Ma´laga, Spain
31 August 2013
