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Confirmation of Cutaneous Metallic Foreign Bodies With a Magnet

Confirmation of Cutaneous Metallic Foreign Bodies With a Magnet Puncture or impalement injuries can result in retained foreign bodies. Removal is warranted to prevent the foreign body from serving as a nidus for infection or producing a foreign-body granuloma. Unfortunately, identifying occult foreign bodies can be difficult. Ultrasonography, plain film radiographs, or metal detectors may be useful, depending on the composition of the material.1 In this case, we were able to confirm the presence of a metallic foreign body simply by applying a household magnet to the unbroken skin overlying a scar. This is an inexpensive way to identify superficial cutaneous metallic foreign bodies. Report of a Case A 15-year-old boy presented with an asymptomatic blue-black macule on the left upper arm. A fragment of material struck his arm causing a puncture wound when he hit a hidden countersunk nail while chopping wood 1 year before. On examination, a barely visible blue-black macule was noted 2 mm superior to a healed scar. No palpable foreign body was appreciated. A common magnet held over the area produced “tenting” of the skin (Figure). A 4-mm punch exposed a metal fragment that was easily removed. The wound was closed with 1 suture. Figure. View LargeDownload Photograph of “tenting” of the skin when a magnet is applied. Comment Small metallic foreign objects that are asymptomatic may be left untreated, but there is a risk of infection, granuloma formation, or migration, especially in the setting of magnetic resonance imaging (MRI).2 In this case, a common magnet proved to be a useful tool in confirming the presence a superficial metallic foreign body. The use of magnets has been described in the plastic surgery, ophthalmologic, and emergency medicine literature for the localization of cutaneous and subcutaneous metallic foreign objects.3-5 “Tenting” of the skin confirms the presence and precise location of ferromagnetic metallic foreign bodies. Once an incision has been made, a magnet covered with a sterile glove can be used to assist in its removal. Of course, foreign bodies in the skin composed of wood, glass, or other nonmetallic material will not be identified using this technique. Using a magnet as an initial diagnostic tool, however, obviates subsequent diagnostic tests if the object is ferromagnetic metal. We recommend that dermatologists keep an inexpensive magnet in their office (retail cost, $2.00-$4.00). This simple tool will prove most useful in identifying metallic foreign bodies, especially symptomatic ones, and in some cases will eliminate the need for expensive diagnostic procedures. In view of the common use of MRI, consideration should be given to removal of asymptomatic ferromagnetic foreign bodies to prevent the potential trauma produced by movement of metal shards during these procedures. Correspondence: Dr Brodell, 2660 E Market St, Warren, OH 44483 (rtb@neoucom.edu). Financial Disclosure: Dr Brodell serves or has served on the speakers bureaus of Allergan, Galderma, GlaxoSmithKline, Dermik, 3M, Novartis, sanofi-aventis, Medicis, and Pharmaderm and serves or has served as consultant to Galderma, Dow, Promius, and Medicis; he has participated in clinical trials for Galderma, Genetech, and Abbott. References 1. Aras MHMiloglu OBarutcugil CKantarci MOzcan EHarorli A Comparison of the sensitivity for detecting foreign bodies among conventional plain radiography, computed tomography and ultrasonography. Dentomaxillofac Radiol 2010;39 (2) 72- 78PubMedGoogle ScholarCrossref 2. Boutin RDBriggs JEWilliamson MR Injuries associated with MR imaging: survey of safety records and methods used to screen patients for metallic foreign bodies before imaging. AJR Am J Roentgenol 1994;162 (1) 189- 194PubMedGoogle ScholarCrossref 3. Cakir BAkan MYildirim SAköz T Localization and removal of ferromagnetic foreign bodies by magnet. Ann Plast Surg 2002;49 (5) 541- 544PubMedGoogle ScholarCrossref 4. Chin JTDavies SJSandler JP Retrieval of a metallic foreign body in the neck with a rare earth magnet. J Accid Emerg Med 2000;17 (5) 383- 384PubMedGoogle ScholarCrossref 5. Dolderer JHKelly JLMorrison WAPenington AJ Foreign-body retrieval using a rare earth magnet. Plast Reconstr Surg 2004;113 (6) 1869- 1870PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Confirmation of Cutaneous Metallic Foreign Bodies With a Magnet

Archives of Dermatology , Volume 147 (5) – May 16, 2011

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Publisher
American Medical Association
Copyright
Copyright © 2011 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archdermatol.2011.105
Publisher site
See Article on Publisher Site

Abstract

Puncture or impalement injuries can result in retained foreign bodies. Removal is warranted to prevent the foreign body from serving as a nidus for infection or producing a foreign-body granuloma. Unfortunately, identifying occult foreign bodies can be difficult. Ultrasonography, plain film radiographs, or metal detectors may be useful, depending on the composition of the material.1 In this case, we were able to confirm the presence of a metallic foreign body simply by applying a household magnet to the unbroken skin overlying a scar. This is an inexpensive way to identify superficial cutaneous metallic foreign bodies. Report of a Case A 15-year-old boy presented with an asymptomatic blue-black macule on the left upper arm. A fragment of material struck his arm causing a puncture wound when he hit a hidden countersunk nail while chopping wood 1 year before. On examination, a barely visible blue-black macule was noted 2 mm superior to a healed scar. No palpable foreign body was appreciated. A common magnet held over the area produced “tenting” of the skin (Figure). A 4-mm punch exposed a metal fragment that was easily removed. The wound was closed with 1 suture. Figure. View LargeDownload Photograph of “tenting” of the skin when a magnet is applied. Comment Small metallic foreign objects that are asymptomatic may be left untreated, but there is a risk of infection, granuloma formation, or migration, especially in the setting of magnetic resonance imaging (MRI).2 In this case, a common magnet proved to be a useful tool in confirming the presence a superficial metallic foreign body. The use of magnets has been described in the plastic surgery, ophthalmologic, and emergency medicine literature for the localization of cutaneous and subcutaneous metallic foreign objects.3-5 “Tenting” of the skin confirms the presence and precise location of ferromagnetic metallic foreign bodies. Once an incision has been made, a magnet covered with a sterile glove can be used to assist in its removal. Of course, foreign bodies in the skin composed of wood, glass, or other nonmetallic material will not be identified using this technique. Using a magnet as an initial diagnostic tool, however, obviates subsequent diagnostic tests if the object is ferromagnetic metal. We recommend that dermatologists keep an inexpensive magnet in their office (retail cost, $2.00-$4.00). This simple tool will prove most useful in identifying metallic foreign bodies, especially symptomatic ones, and in some cases will eliminate the need for expensive diagnostic procedures. In view of the common use of MRI, consideration should be given to removal of asymptomatic ferromagnetic foreign bodies to prevent the potential trauma produced by movement of metal shards during these procedures. Correspondence: Dr Brodell, 2660 E Market St, Warren, OH 44483 (rtb@neoucom.edu). Financial Disclosure: Dr Brodell serves or has served on the speakers bureaus of Allergan, Galderma, GlaxoSmithKline, Dermik, 3M, Novartis, sanofi-aventis, Medicis, and Pharmaderm and serves or has served as consultant to Galderma, Dow, Promius, and Medicis; he has participated in clinical trials for Galderma, Genetech, and Abbott. References 1. Aras MHMiloglu OBarutcugil CKantarci MOzcan EHarorli A Comparison of the sensitivity for detecting foreign bodies among conventional plain radiography, computed tomography and ultrasonography. Dentomaxillofac Radiol 2010;39 (2) 72- 78PubMedGoogle ScholarCrossref 2. Boutin RDBriggs JEWilliamson MR Injuries associated with MR imaging: survey of safety records and methods used to screen patients for metallic foreign bodies before imaging. AJR Am J Roentgenol 1994;162 (1) 189- 194PubMedGoogle ScholarCrossref 3. Cakir BAkan MYildirim SAköz T Localization and removal of ferromagnetic foreign bodies by magnet. Ann Plast Surg 2002;49 (5) 541- 544PubMedGoogle ScholarCrossref 4. Chin JTDavies SJSandler JP Retrieval of a metallic foreign body in the neck with a rare earth magnet. J Accid Emerg Med 2000;17 (5) 383- 384PubMedGoogle ScholarCrossref 5. Dolderer JHKelly JLMorrison WAPenington AJ Foreign-body retrieval using a rare earth magnet. Plast Reconstr Surg 2004;113 (6) 1869- 1870PubMedGoogle ScholarCrossref

Journal

Archives of DermatologyAmerican Medical Association

Published: May 16, 2011

Keywords: foreign bodies,magnets

References