Glass Fragment Removal from Hand
Remove glass fragments from the hand through formal surgical exploration under adequate anesthesia with proper wound irrigation, debridement, and direct visualization—never attempt blind probing or removal in the office setting.
Diagnostic Imaging First
Always obtain plain radiographs before attempting removal. Glass fragments are radiopaque and readily visible on x-ray, yet radiographs are frequently not obtained despite their low cost and high efficacy 1. The adverse consequences of retained foreign bodies—including infection, delayed healing, persistent pain, and late injury from fragment migration—far outweigh any objections to obtaining imaging 1.
Surgical Exploration Under Anesthesia
Perform formal exploration under adequate anesthesia or analgesia rather than attempting office-based removal 2. Glass injuries commonly disguise extensive underlying damage beneath innocent-appearing skin wounds 3.
Key structures at risk by location:
Above the elbow (in order of injury frequency) 3:
- Median nerve (75%)
- Brachial artery (58%)
- Ulnar nerve (50%)
- Musculocutaneous nerve (33%)
Below the elbow 3:
- Ulnar nerve (71%)
- Ulnar artery (57%)
- Flexor carpi ulnaris (57%)
- Flexor tendons—superficialis and profundus (43%)
- Median nerve (43%)
Proper Surgical Technique
Preparation and Antisepsis
Perform surgical hand antisepsis before the procedure using antimicrobial soap and water, or soap and water followed by alcohol-based surgical hand-scrub with persistent activity 4. This 2-3 minute scrubbing protocol reduces bacterial counts to acceptable levels and prevents surgical site infections that significantly impact morbidity, mortality, and quality of life 4.
Wound Management Steps
Copious irrigation under moderate pressure is the single most important factor influencing subsequent wound healing 2. Incomplete removal of devitalized or contaminated tissue is the most common cause of wound infection, breakdown, and delayed healing 2.
Thorough debridement under continuous irrigation must be performed—this is tedious and time-consuming but critical 2. Remove all devitalized tissue, contaminated material, and glass fragments under direct visualization 2.
Control edema immediately with light pressure bandages to minimize swelling, as tension on the wound compromises blood supply 5, 2.
Wound Closure Decision
Do not close the wound prematurely. If there is any doubt about complete debridement after initial exploration, cover the wound with proper dressing and perform delayed closure 2. Premature closure results in dehiscence and infection within days 2.
Consider healing by second intention or delayed closure more often—this approach should be used whenever adequate debridement cannot be confirmed 2.
If drainage is needed:
- Active drainage is more efficient than passive Penrose drains 2
- Cover exposed drain ends with sterile, absorbent dressing 2
- Improper drain use causes more problems than no drainage 2
Infection Prevention
Standard precautions apply throughout the procedure 6:
- Perform hand hygiene before and after patient contact 6
- Wear gloves when contact with blood or body fluids is anticipated 6
- Use appropriate masks and protective eyewear during procedures likely to generate droplets 6
Sharp instruments contaminated with patient blood must be handled with care to prevent injuries 6. Place used sharp items in puncture-resistant containers located close to the procedure area 6.
Post-Procedure Management
Provide adequate analgesia—the patient's pain response may cause immunocompromise, increasing infection rates and impairing wound healing 2. Pain can induce a hypermetabolic state resulting in multiple organ dysfunction 2.
Monitor for complications including infection, delayed healing, and persistent pain from retained fragments 1. Early exploration with vascular repair and microneurorrhaphy when needed produces remarkably good outcomes, even in children 3.
Critical Pitfalls to Avoid
- Never attempt blind probing or office-based removal without imaging and proper anesthesia
- Never skip radiographs—glass is radiopaque and easily detected 1
- Never underestimate the extent of injury based on external appearance alone 3
- Never close wounds prematurely before confirming complete debridement 2
- Never fail to control edema as it compromises blood supply and healing 5