Splinter is a foreign body embedded under a person’s skin. The presence of a fragment of glass, metal, wood in the epidermis or dermis is accompanied by a tingling sensation when pressed. Within a few hours, local inflammation develops, which can turn into suppuration. To clarify the location of the glass or metal splinter, the state of the anatomical structures surrounding the fragment, soft tissue ultrasound, radiography, and MRI diagnostics may be necessary. Surface splinters are easily removed with a needle, tweezers. A deeply located foreign body, glass fragments can be removed from tissues only by a dermatologist or surgeon.
T14.0 Superficial trauma of an unspecified body area
In dermatology, splinters are common among patients of all ages. Fingers and palms are most often affected; heels and the arch of the foot are in second place. Most of the foreign bodies do not penetrate deeper than the epidermis, does not create health problems. Splinters that affect the dermis require attention. These fragments can become a source of a purulent infection, which actively spreads in the tissues, leading to the development of complications. In everyday life, most cases of subcutaneous introduction of splinters occur during the warm season, when the activity of people outside the house increases, the summer gardening season begins. In the production sector, there is no dependence on seasonality, non-compliance with safety regulations is important here.
The predisposing factor is the performance of work related to the processing of wood, metals, cultivation and harvesting of plants. Careless conduct of individual operations, work without protective gloves, clothing and shoes easily leads to the penetration of foreign bodies under the skin. Depending on the conditions of damage , the following causes of splinter formation are distinguished:
- Household. This includes all cases of splinters in children and adults received at home. In children, this is a consequence of pranks, crawling on a wooden floor or surfaces contaminated with sharp fragments that easily penetrate the epidermis. Children of the first year of life can splinter palms, feet, forearm skin, knees. In adults, a splinter is a frequent companion of repair work, a number of everyday tasks.
- Production. The greatest risk of getting splinters are representatives of such professions as carpenters, carpenters, grinders, glass blowers, millers, locksmiths. They suffer not only their hands, but also their face, since when working with machines, small foreign bodies can fly in different directions with considerable speed. In these professions, the use of protective glasses, gloves, masks, overalls is of paramount importance.
- Agricultural. Flower growers, vegetable growers, field brigade workers are in the most vulnerable position. This is due to the fact that organic fragments with soil particles, once under the skin, most often cause a violent local inflammatory reaction, create an increased risk of tetanus. Constant contact with the ground increases the risk of infection of wounds left after the removal of splinters.
The most significant reason for the complicated course of the splinter is the frivolous attitude of many people to this problem. The danger at the time of the introduction of a splinter is a temporary decrease in immunity due to colds, fatigue, overheating or hypothermia; persistent weakening of the body’s defenses in patients with diabetes mellitus, chronic circulatory disorders, chronic alcoholism and other severe pathology. Along with the ubiquitous staphylococci and Streptococci, Pseudomonas aeruginosa and other highly pathogenic microorganisms can get into the wound. The lack of tetanus vaccination can also play a negative role.
Tissue damage affecting the dermis causes swelling due to increased capillary permeability and fluid release into the interstitial space. A foreign body provokes the development of reactive inflammation. The presence of bacteria in the wound leads to suppuration. If the immune system cannot limit inflammation, then bacteria begin to spread in the tissues with the formation of phlegmon. Prolonged presence of the fragment in the tissues ends with the formation of inflammatory granuloma. This is a small pineal seal under the skin, which hurts when pressed and gradually increases in size. The development of granuloma is based on the growth of connective tissue, which separates the foreign material, forms a capsule around it.
An opaque foreign body is clearly visible under the skin, and its tip sometimes protrudes above the surface of the epidermis. Pain is not characteristic. There is a tingling sensation when pressing on the area of damage. The exception is the sub-elbow splinter: a small foreign fragment provokes intense pain, which increases when touching the nail phalanx. If the injury site is not treated in a timely manner, an inflammatory process develops, which significantly changes the clinical picture. A site of purulent inflammation is formed. When an abscess with liquid contents is opened, a foreign fragment usually comes out. If the inflammation spreads to the surrounding tissues, then pain may appear, pronounced swelling of the entire anatomical area. One of the manifestations of finger edema is the stiffness of the interphalangeal joints.
A feature of the structure of finger tissues is the presence of numerous connective tissue jumpers. As a result, pus often cannot break out and goes deep into the tissues with the formation of a panaritium. On the hands, feet and other parts of the body, spilled inflammation leads to phlegmon. Granuloma on the hand causes constant discomfort when performing small movements, can be periodically injured if it rises above the skin level. One of the most formidable complications of splinters is tetanus, which develops when clostridium tetani enters the wound in unvaccinated individuals. At the current level of medical development, the mortality rate from tetanus, according to various sources, ranges from 17 to 25%. The greatest number of cases of tetanus is observed in rural areas.
Making the correct diagnosis does not cause difficulties. Exceptions are cases when the foreign body is transparent or has sunk deep into the tissue, there are signs of neurological disorders or surgical pathology. Doctors of other specialties can work in a team with a dermatologist: radiologist, neurologist, surgeon, traumatologist. For diagnostics , the following are used:
Visual inspection. Allows you to determine the material of a foreign body, the size and depth of its occurrence, the presence of signs of inflammation. Inspection data, as a rule, is enough to choose the most appropriate way to remove the splinter. Palpation of the injury site is performed in order to detect edema, local soreness and tingling, to determine the condition of the surrounding tissues.
Instrumental research methods. Taking into account the clinical picture, ultrasound, X-ray examination, CT or MRI of soft tissues may be prescribed. This is necessary to visualize transparent foreign bodies and clarify their location, monitor the condition of adjacent joints and other anatomical structures.
Removal of intradermal and subcutaneous foreign bodies is carried out both at home and in a medical institution. With minor injuries, patients go to the emergency room, where the damaged area is treated, the necessary measures are taken to prevent complications. If there are signs of complications, the patient is referred to the surgeon. Therapeutic tactics include:
- Observation. Small fragments located in the upper layers of the skin can not be reached. They will be rejected together with the peeling epithelium within a couple of days. Additional exposure to a non-sterile needle leads to the appearance of small infected wounds, the harm from which is greater than from a superficially located splinter.
- Removal with a needle or tweezers. A deeply located splinter must be removed. If its tip sticks out, then it is enough to grab it with tweezers and pull it out. If the fragment has gone deep, then it is first necessary to tear the epidermis above the splinter with a sterile needle, and remove the splinter itself with tweezers. Instead of a needle, you can use cuticle tweezers, which cut off the layer of dead epithelium over a foreign body.
- Removal in the emergency room. It is not always possible to pull out a splinter without help. In this case, you can contact the emergency room. It is necessary to take a vaccination card with you so that the health worker knows whether it is necessary to carry out an emergency vaccination against tetanus.
- Treatment of complications. An active inflammatory process at the site of injury requires additional treatment. Antibiotics, anti-inflammatory drugs, and physiotherapy are prescribed. In the absence of the effect of conservative therapy, a surgical opening of the abscess is performed, during which conditions are created for the outflow of pus and rapid tissue healing.
Prognosis and prevention
The prognosis is favorable, provided competent removal of splinters and treatment of wounds, timely vaccination. Prevention consists in the use of protective equipment for the most vulnerable areas of the body (protective gloves for hands, suitable shoes, glasses or face masks). Timely seeking medical help, fulfilling doctor’s prescriptions, and creating rest for the injured limb allows you to prevent the development of complications. This is especially important for patients with immunodeficiency, severe pathology of the cardiovascular system, internal organs.