Fishhook Removal from the Leg
For a barbed fishhook embedded in the leg, use the "advance and cut" (push-through) technique, which is the most effective method for hooks embedded close to the skin surface and is almost always successful even for large fishhooks. 1
Initial Assessment
Before attempting removal, carefully evaluate the following:
- Depth of penetration – Determine how deeply the barb is embedded 1
- Hook orientation – Consider radiography to identify the hook type and its exact position 2
- Surrounding structures – Assess for involvement of tendons, nerves, or blood vessels 1
- Location – Ensure the injury is not near critical structures that would require specialist referral 1
Removal Technique: Advance and Cut Method
This is the preferred technique for most fishhook injuries:
Anesthetize the area with local anesthetic around the entry site and along the anticipated exit path 1
Push the hook forward through the skin, following the curve of the hook until the barb exits through a new puncture site 1, 3
Cut off the barb using wire cutters or similar tool once it emerges 1, 3
Back the hook out through the original entry wound after the barb is removed 1
Alternative Techniques (When Advance and Cut is Not Feasible)
Retrograde technique: Pull the hook back along its entry path – simplest but least successful method, only works if the barb hasn't fully engaged 1
String-yank method: Can be performed in the field, often without anesthesia, by using string to rapidly extract the hook 1
Post-Removal Wound Care
- Irrigate copiously with water to remove foreign material 4, 5
- Extract any remaining foreign bodies from the wound 1
- Apply antibiotic ointment and a clean occlusive dressing 5
- Prophylactic antibiotics targeting Aeromonas species should be initiated to prevent infection 3
- Assess tetanus status and administer toxoid if needed 1
Critical Pitfalls to Avoid
- Do not attempt simple retrograde removal if the barb is fully embedded – this will cause significant tissue trauma 1
- Never refer to ophthalmology immediately if there is any ocular involvement rather than attempting removal 1
- Do not skip anesthesia – proper local anesthesia is essential for controlled, atraumatic removal 3