Kansas City University of Medicine and Biosciences, Kansas City, MO, USA.
Division of Pediatric Surgery, Children's National Hospital, Washington DC, USA.
Surg Innov. 2023 Oct;30(5):571-575. doi: 10.1177/15533506231158209. Epub 2023 Mar 14.
Metallic foreign bodies (mFB) are common following penetrating injuries in children. The mFB commonly occur in the head and neck region and extremity soft tissues. Removal may be indicated due to morbidity related to pain or migration. Extraction can be challenging to localize, often requiring wide exposure, and may be difficult to achieve in cosmetically sensitive areas. Different technological adjuncts have been used to facilitate foreign body removal including fluoroscopy, ultrasound, and more recently in adults, surgical magnets. The most powerful commercially available magnets are rare earth magnets comprised of neodymium iron and boron (Ndy). With the goal of reducing radiation exposure and the morbidity of mFB removal with associated soft tissue injury in children, a strategy was introduced utilizing Ndy to optimize extraction with minimal soft tissue surgical dissection.
Two children with extremity mFB treated with Ndy between January 2021 and July 2021 were analyzed. We utilized commercially available ring type neodymium-iron-boron magnets with dimensions of 1 3/8-inch outer diameter x 1/8-inch inner diameter and 1/16 inch thick with a power of 13 200 gauss that were processed for use according to our hospital protocols. Our main clinical indication was for the detection and retrieval of small ferromagnetic foreign bodies embedded in superficial extremity soft tissues.
In the operating room under general anesthesia, the mFB were localized utilizing fluoroscopy. A 1.0 cm skin incision was made into the subdermal soft tissues overlying the area of the mFB. No surgical tissue dissection was performed. The mFB could not be visualized in the soft tissue. Using fluoroscopy to localize the mFB, the Ndy was then placed into the wound in close proximity to the mFB. The mFB were immediately magnetized to the Ndy and the mFB were extracted from the soft tissues without any further surgical dissection. Two simple interrupted nylon sutures were placed to close the incision. The total operative time was 2 and 2.5 minutes respectively. The children recovered uneventfully and are without complication.
The use of Ndy to remove extremity soft tissue mFB in children appears to be feasible, safe, and efficient. Use of the Ndy allowed extraction via a small incision, optimizing the aesthetic result and avoiding the need for cross-sectional imaging, extensive surgical dissection, tissue reconstruction and prolonged operative time or x-ray exposure. The development of magnets of increasing energy density may be indicated to further optimize metallic soft tissue foreign body extraction in children in a minimally invasive manner.
金属异物（mFB）在儿童穿透性损伤后很常见。mFB 通常发生在头部和颈部区域以及四肢软组织。由于与疼痛或迁移相关的发病率，可能需要进行去除。由于定位困难，通常需要广泛暴露，并且在美容敏感区域可能难以实现。已经使用了不同的技术辅助物来促进异物去除，包括透视、超声，以及最近在成人中使用的手术磁铁。最强大的商业上可用的磁铁是由钕铁和硼（Ndy）组成的稀土磁铁。为了减少儿童 mFB 去除相关软组织损伤的辐射暴露和发病率，引入了一种策略，即利用 Ndy 优化提取，最大限度地减少软组织手术解剖。
分析了 2021 年 1 月至 2021 年 7 月期间使用 Ndy 治疗的 2 例四肢 mFB 患儿。我们使用了商业上可获得的环形钕铁硼磁铁，尺寸为 1 3/8 英寸外径 x 1/8 英寸内径和 1/16 英寸厚，磁力为 13,200 高斯，根据我们医院的协议进行了处理。我们的主要临床指征是检测和检索嵌入四肢软组织浅表的小铁磁异物。
在全身麻醉下的手术室中，利用透视术定位 mFB。在 mFB 所在的皮下软组织上做一个 1.0 厘米的皮肤切口。未进行任何手术组织解剖。在软组织中无法看到 mFB。通过透视术定位 mFB，然后将 Ndy 放置在 mFB 附近的伤口中。mFB 立即被 Ndy 磁化，mFB 无需进一步手术解剖即可从软组织中取出。放置 2 个简单的间断尼龙缝线以关闭切口。总手术时间分别为 2 分钟和 2.5 分钟。患儿恢复顺利，无并发症。
在儿童中使用 Ndy 去除四肢软组织 mFB 似乎是可行、安全且有效的。使用 Ndy 可以通过小切口进行提取，优化美容效果，避免需要进行横断面成像、广泛的手术解剖、组织重建以及延长手术时间或 X 射线暴露。可能需要开发能量密度不断增加的磁铁，以进一步优化微创方式儿童金属软组织异物的提取。
