PA Damages Patient’s Hand During Removal of Foreign Body

This case involves a male patient who presented to his local emergency room with a triple hook fishing lure embedded in his left hand in between the first and second metacarpal web space. The patient was first seen by a physician’s assistant who unsuccessfully attempted to remove the fish hook by cutting away the secondary hooks haphazardly, leaving several fragments of metal in the patient’s skin. The patient was then sent for x-ray imaging that revealed a metallic foreign body in the anterior soft tissue between the thumb and index finger. The patient was advised that he would be placed on oral Bactrim and that he should follow-up with a hand surgeon in the outpatient setting. The patient’s discharge diagnosis was “embedded metal fragment.” The next day, the patient noticed several raised bumps on the back of his hand near the wound, with eventual spread to his forearm. He presented to a different hospital, where he was admitted for a superficial foreign body reaction and severe infection. Later that night, the patient was taken in for exploratory surgery of the hand and removal of the remaining fish hook debris. Following his treatment, the patient complained of residual numbness of the tip of his left thumb, which he attributed to the untreated infection.

Question(s) For Expert Witness

1. Could this patient's complications have been avoided if the foreign body was removed properly during the first visit?

Expert Witness Response E-000350

No single technique is best for the removal of soft tissue foreign bodies, but an experienced practitioner involved in the extraction is paramount. The physician's assistant probably should have deferred to the ER physician on call for help if the entire foreign body could not be removed. Additionally, a hand surgeon should have been consulted before the patient was discharged to ensure that no long-term damage was evident.