Retrieval of a Subcutaneous Needle using High-frequency Ultrasound

Remnants of a broken surgical needle may remain within the tissue and cause discomfort and pain as well as artifacts on magnetic resonance imaging. In addition, legal problems may arise when efforts of retrieval have not been documented.

Nearly every experienced surgeon knows how annoying it can be to miss a part of a needle at the very end of a long operation. Metallic foreign bodies can be visualized by fluoroscopy and ultrasound,[1] but they do not facilitate the salvage of small particles. Ultrasound is available in most neurosurgery suites today, but most probes have large contact surfaces > 200 mm² and do not allow an exact localization, especially within distances less than a centimeter. Moreover, an aggressive search can cause healing problems and necroses.

We report a simple trick for extracting needles from a wound with minimal trauma.

A 54 year-old woman was operated on in a prone position at the cervicothoracic junction. During closure of the wound, the resident noticed the loss of large parts of a needle he used for subcutaneous suturing. In spite his certainty about the needle's position, it could not be salvaged.

The needle position within the subcutaneous tissue was identified using high-frequency ultrasound (BK Ultrasound, Herlev, Denmark, hockey-stick probe 8809) ([Fig. 1]), but it could not be seen even under the microscope.

Fig. 1 Intraoperative situation. The ultrasound probe is placed on the skin and displays the needle. The cannula has been inserted under ultrasound control.

The ultrasound probe was kept in that position on the skin. To provide a guide toward the needle, a 22G cannula was inserted into a position where it could be visualized in the same image plane as the broken needle ([Fig. 2]). Then the needle was extracted with minimal additional trauma by following the course of the cannula, in this case microsurgically.

Fig. 2 A 15-MHz ultrasound image after insertion of the cannula that can be identified as a straight signal pointing toward the needle.

This simple method helps ease the search for a broken needle and avoids tissue damage.

• Reference

• 1 Allouch H, Behnke-Mursch J, Mursch K. Retrieval of foreign bodies adjacent to the nervous system: aspects of intra-operative use of ultrasound. Acta Neurochir (Wien) 2008; 150 (01) 63-65 ; discussion 66