Push-through and snip method explained

Contributor: Megan Hurley, MD

Educational Pearls:

Assess first: confirm the hook isn't near vital structures.

• Automatic subspecialty consult for eye involvement or proximity to carotid artery, radial artery, peritoneum, testicle, or urethra
• Barbed hook: cannot be pulled back through the entry without disengaging the barb

Removal Techniques

1. String-Pull: best for superficial, single-barbed hooks
   • Depress shank and eye of hook to disengage barb and then pull string taut and jerk suddenly along the long axis
   • Can only be used when the hook is in a body part that can be firmly secured so it won't move during the procedure
   • Little or no anesthesia needed
2. Push-Through & Snip: best choice when barb is near the skin surface
   • Anesthetize first and advance the hook forward until the barb emerges. Cut off the barb and then back hook out
   • Small exit wound, no sutures needed
3. Needle Cover: for larger hooks that are superficial
   • Anesthetize first and then slide an 18 or 20-gauge needle along the hook until the bevel covers the barb. Then back out the needle and hook together
4. Cut-it-out: last resort
   • Make an incision along the body of hook to barb and then remove hook

Adjuncts: Hydrodissection with lidocaine along the tract can ease removal Post-Procedure

• Irrigate thoroughly and apply antibiotic ointment
• Routine prophylaxis not needed because complications are rare
  • Consider prophylactic antibiotics if hook is deeply embedded in high-risk area or contaminated by fresh water or salt water

References

1. Aiello LP, Iwamoto M, Guyer DR. Penetrating ocular fish-hook injuries. Surgical management and long-term visual outcome. Ophthalmology. 1992 Jun;99(6):862-6. doi: 10.1016/s0161-6420(92)31881-0. PMID: 1630774.
2. Malitz DI. Fish-hook injuries. Ophthalmology. 1993 Jan;100(1):3-4. doi: 10.1016/s0161-6420(93)31700-8. PMID: 8433823.

Summarized by Meg Joyce, MS2 | Edited by Meg Joyce & Jorge Chalit, OMS4