We receive patients with needles, bullets, glass fragments, metal dust and various other materials retained in puncture wounds..... Mostly we explore and remove these in Emergency department...
In general, bullets and bullet fragments are often left in place depending on their location and difficulty in removing. Often more harm can be done by attempting to remove them, but of course this depends on the location and whether it is causing problems for the patient (risk/benefit). In general wounds should be well irrigated to remove any foreign body at this could be a future source of infection, inflammation, or discomfort to the patient.
Generally we remove any foreign material and devitalised tissue at the initial exploration of the wound. Long term, foreign bodies are only removed if they become symptomatic. Fortunately we only very rarely encounter firearm injuries.
Our experience in this topic is vast n we prefer to remove all such foreign bodies if its fresh in nature. some times pt. comes with the history of trauma earlier with asymptomatic foreign bodies. may be due to fibrosis. prefer not to remove untill pt asked to remove.
I agree that longstanding foreign bodies can usually be left in place; others should be removed if easily accessible. One particular foreign body that I like to insure is removed is a puncture wound of the foot where the puncturing object penetrates the sneaker being worn. Often this leaves a tiny piece of rubber from the sneaker sole. I like to core out the puncture wound to be sure this foreign body is removed, a sterilized cork borer is very helpful to use. This markedly reduces the incidence of pseudomonas osteomyelitis of the foot. When the foreign body is removed, there is no need for prophylactic antibiotics.
Very nice answer, most of which I agree with; but so far as removing bullet for forensic purposes, most are so deformed that they are worthless as evidence, and ethically, if it doesn't benefit the patient, I don't see how one can justify the risk of surgery just to acquire a piece of evidence that more likely than not, will be useless
I was once ordered by a judge to do so; the bullet was clearly fragmented and would have been useless, and I refused. I was threatened with being sent to prison, but I finally had a chance to explain to the judge why I was refusing, and he let it pass.
Thanks all. I am really grateful for your precious input and thought provoking answers.....We also have difficulty in dealing with judges as they are not good at Medical Jurisprudence(i hope i spelled it right) and we the surgeons are not good at Forensic medicine....
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