Factors affecting management:
(1) nature of the impaling object (metal vs plastic vs wood vs other organic)
(2) extent of environmental contamination
(3) penetration of organs (bowel, orbit, diaphragm, pleura, etc.)
(4) tamponade by the object of penetrated vascular structures
(5) vascular injury
(6) neurological injury
(7) contusion and blunt trauma of adjacent organs
(8) fractures
(9) injuries affecting ventilation
Management:
(1) The foreign object should not be removed in the field since uncontrolled hemorrhage may occur. The external material may be cut down to facilitate transport.
(2) The surgical team should be prepared for significant hemorrhage on removal of the object.
(3) All of the impaling material, devitalized tissue and environmental contamination should be carefully removed.
(4) Major vascular injuries should be repaired early. Thrombosis should be identified and treated.
(5) Intraoperative evaluation of neurologic function (measurement of action potentials, cortical somatosensory evoked potentials, other) can help identify nerve injuries.
(6) Any penetrating or blunt injuries affecting ventilation (airway obstruction, pneumothorax, hemothorax, diaphragmatic injury, etc.) should be identified and treated.
(7) Penetrating injuries to vital structures should be identified and repaired.
(8) Soft tissue closure is usually delayed.
(9) Prophylactic antibiotics and tetanus vaccination should be given.
