Soft Tissue Case 3 ED Management

The decision to remove a WFB or leave it in situ should be made on a case-by-case basis. Factors to consider are:

• Size
• Location
• Material
• Infection risk/contamination
• Associated symptoms
• Likelihood of future complications

If a WFB is small, in a harmless location, deep, asymptomatic, and an inert material (i.e. glass, metal), than it may be more damaging to attempt removal than to leave it in place. A WFB that is causing symptoms, soiled, in a location likely to cause future problems (i.e. sole of foot), or a reactive material (i.e. wood) is more likely to require removal.
Not all WFBs can be removed by irrigation or exploration in the ED. In these cases, the area should be padded and the patient should be referred to the appropriate consultant for removal. Consider antibiotics for retained WFBs. Be sure to inform patients when a WFB is left in situ so that they know to seek care if a complication develops.