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Exploration of wounds and removal of small penetrating subcutaneous foreign bodies is often technically difficult and time-consuming. The use of fluoroscopy in theatre can be time-consuming, requires a radiographer and results in radiation exposure for both patient and surgeon. The use of ultrasound as a diagnostic tool has been shown to be sensitive and specific in identifying foreign bodies.1
In our hospital, we have been using a Sonosite 180 Plus (Sonosite Inc., 21919 30th Drive, Bothell, WA, USA) portable ultrasound unit to identify and locate foreign bodies prior to exploration either in the emergency department or in theatre. Using the probe, the exact depth and location of the foreign body (including proximity to surrounding structures) is calculated. Prior to exploration, the skin is marked. The ultrasound probe can also be used intra-operatively in conjunction with a sterile latex cover to identify and locate residual fragments.
We have found that this method is easy to learn and quick to perform. It uses equipment readily available in emergency and operating departments and does not require extra staff. It negates the need to expose the patient and the operator to radiation. Its use in the emergency department in combination with local anaesthesia can prevent unnecessary operation. Using the probe intra-operatively can help prevent unnecessarily extensive tissue dissection.