Application of Intraoperative Navigation and Positioning System in the Removal of Deep Foreign Bodies in the Limbs

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Application of Intraoperative Navigation and Positioning System in the Removal of Deep Foreign Bodies in the Limbs

Authors: Hai-Dong Liang 1, Hong Li2, Hao Feng1, Zheng-Nan Zhao1, Wen-Ji Song1, Bo Yuan1

Author Affiliations:

  1. Department of Hands and Feet Microsurgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116023, China
  2. Department of Pharmacy, Fushun Central Hospital, Fushun, Liaoning 113006, China

Introduction

Foreign bodies in the human body can cause secondary trauma and patient discomfort. While those just beneath the skin are easy to remove, deep-lying and small foreign bodies in soft tissues pose challenges. They can lead to tissue damage, delayed wound healing, infection, allergic reactions, and late injury due to migration. Surgical removal of such foreign bodies is often time-consuming and causes more trauma to surrounding tissues. The incidence of retained foreign bodies varies widely.

Case Presentation

A 41-year-old man presented with a metallic machine needle in his left thigh for 3 days. Standard anteroposterior and lateral X-rays confirmed a deep-seated radio-opaque foreign body (Figures 1A and 1B). Surgical intervention was planned. After anesthesia, a grid construct made of radio-opaque threads and plastic film was placed over the approximate foreign body site (Figure 1C). X-ray showed the foreign body’s position in the grid (Figure 1D). Precise localization with a needle and C-arm X-ray machine (Insight2, Shawnee, KS, USA; C-arm) in different planes was done, and 0.3-mL methylene blue was injected (Figures 1E and 1F). The skin was incised, the neurovascular bundle was protected, and the foreign body was found in the blue-stained area and removed successfully (Figure 1G). C-arm confirmed removal, and the wound was closed after tourniquet release, hemostasis, and washout (Figures 1H and 1I).

Current Surgical Approaches and Limitations

So far, no standardized surgical procedures for limb foreign body removal exist. Wen et al. used enhanced computed tomography and three-dimensional angiography to show the foreign body’s location and spatial relationship with blood vessels for surgical guidance. Fu et al. demonstrated ultrasound-guided extraction of soft-tissue foreign bodies. These procedures are successful but rely on special equipment and involve significant radioactivity, limiting their generalization.

The Proposed Intraoperative Navigation and Positioning System

Our system uses a double positioning system combining a sterile syringe needle, film, C-arm, and methylene blue for more accurate localization. This technique has several advantages:

  • Simplicity and Speed: It is simple, fast, and cost-effective.
  • Accuracy: Shortens operation time and reduces radiation exposure for patients and theater staff.
  • Small Incision and High Success Rate: Requires a small incision and minimal exploration with a high success rate, making it suitable for generalizing foreign body extraction from extremities.

Patient Consent and Ethical Considerations

The authors obtained appropriate patient consent forms. Patients/guardians consented to the reporting of images and clinical information, understanding that names and initials would not be published, and efforts would be made to conceal identity (though anonymity cannot be guaranteed).

Conclusion

The intraoperative navigation and positioning system described here offers a promising approach for the removal of deep foreign bodies in the limbs. Its simplicity, accuracy, and other advantages make it a valuable addition to the surgical armamentarium for such cases.

References:

  1. Hocaoğlu E, Kuvat SV, Özalp B, Akhmedov A, Doğan Y, Kozanoğlu E, et al. Foreign body penetrations of hand and wrist: a retrospective study. Turkish J Trauma Emerg Surg 2013;19:58–64. doi: 10.5505/tjtes.2013.04453
  2. O’Brien L, Eyster KM, Hansen KA. Retained foreign body: “Needle in a Haystack.” J Patient Safe 2015;11:228–229. doi: 10.1097/pts.0000000000000078
  3. Nan GX, Cai WQ, Su YX, Qin JQ, Liu X, Wang ZL, et al. Use of methylene blue marking for removal of tiny foreign metal in soft tissue in children. Chin J Pediatr Surg 2013;34:119–122. doi: 10.3760/cma.j.issn.0253-3006.2013.02.011
  4. Wen YH, Hou WJ, Lei WB, Chen FH, Zhu XL, Wang ZF, et al. Clinical characteristics and endoscopic endonasal removal of foreign bodies within sinuses, orbit, and skull base. Chin Med J 2017;130:1816–1823. doi: 10.4103/0366-6999.211545
  5. Fu Y, Cui LG, Romagnoli C, Li ZQ, Lei YT. Ultrasound-guided removal of retained soft tissue foreign body with late presentation. Chin Med J 2017;130:1753–1754. doi: 10.4103/0366-6999.209910

How to Cite: Liang HD, Li H, Feng H, Zhao ZN, Song WJ, Yuan B. Application of intraoperative navigation and positioning system in the removal of deep foreign bodies in the limbs. Chin Med J 2019;132:1375–1377. doi: 10.1097/CM9.0000000000000253

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