Fishhooks have a variety of sizes and shapes based on a common pattern. The barb, which is a projection extending backward from the point of the hook, keeps the point embedded in the fish's mouth and makes removal from skin a challenging task. Most injuries with fishhooks involve the hand, head, or face.

Several methods for removing fishhooks in skin have been reported.

The best strategy depends primarily on the depth of the hook. If the hook has multiple barbs, precautions should be taken to avoid impaling the treating physician, bystanders, or the patient (a second time) during removal by taping or cutting off the exposed barbs. With any technique, the skin should be prepared and anesthetized at the entry site. If the hook is superficial, gentle downward pressure is placed on the shank while the hook is simply pulled in a retrograde direction along the path of entry.




Simple retrograde technique for fishhook removal. While pressing the skin over the tip of the hook to disengage the barb and applying gentle downward pressure on the shank, the physician backs the hook out of the skin. If the barb catches on skin fibers, other techniques must be used.

String-pull technique for fishhook removal. String or suture material is tied to the curve of the hook. The hook is positioned as described in the simple retrograde technique (Figure 49-18), and a quick pull on the string will dislodge the hook

Needle-cover technique for fishhook removal. The area is anesthetized, and an 18-gauge needle is inserted into the entrance wound along the hook. The lumen of the needle is placed over the barb to cover it, and both the hook and needle are backed out of the wound

The advance-and-cut technique
The advance-and-cut technique is useful for deeply penetrated and larger fishhooks. The tip of the hook is advanced through the skin surface. Once exposed, the point and barb are cut with wire cutters, and the remaining part of the hook is rotated back out of the original wound. If barbs along the shank are embedded beneath the dermis, the shank can be clipped near the hook's eye. The remaining part of the hook is then passed antegrade through the skin. Because the advance-and-cut method further traumatizes and contaminates tissue, it probably should be reserved for wilderness situations. However, this may be an effective method in the ED if the barb has nearly or already penetrated the surface of the skin or is embedded within a joint, cartilage, or tendon

Advance-and-cut technique for fishhook removal.
The area is anesthetized, and the tip of the hook is advanced through the skin surface (A), the barb is cut (B), and the hook is rotated back out of the original wound (C).

The incision technique

Incision technique for fishhook removal. The area is anesthetized, and a small incision is made along the shaft of the hook to the barb. The hook is withdrawn through the incision.

The incision technique is nearly always successful in removing fishhooks. The entrance wound is enlarged to 2 to 3 mm with a #11 scalpel blade. The incision is carried along the bend of the hook to the barb until the barb is disengaged from the soft tissue. The hook can then be withdrawn easily through the larger entrance. If necessary, the barb can be grasped with a hemostat to prevent it from snagging tissue on the way out. There are two major benefits to enlarging puncture wounds containing foreign bodies. First, the wound is more easily inspected for additional foreign bodies. In the case of fishhook impalement, the wound may be harboring the bait that was on the hook. Second, the wound tract is more easily irrigated through a larger opening. However, the incising scalpel can easily injure tendons, nerves, and vessels