Removal Of Double Pointed Tacks

Sources: A Manual Of Peroral Endoscopy And Laryngeal Surgery

If the tack or staple be small,

and lodged in a relatively large trachea a version may be done. That

is, the staple may be turned over with the hook or rotation forceps

and brought out with the points trailing. With a long staple in a

child's trachea the best method is to coax the intruder along gently

under ocular guidance, never making traction enough to bury the point

deeply, and lifting the point with the hook whenever it shows any

inclination to enter the wall. Great care and dexterity are required

to get the intruder through the glottis. In certain locations, one or

both points may be turned into branch bronchi as illustrated in Fig.

88, or over the carina into the opposite main bronchus. Another method

is to get both points into the tube-mouth. This may be favored, as

demonstrated by my assistant, Dr. Gabriel Tucker, by tilting the

staple so as to get both points into the longest diameter of the

tube-mouth. In some cases I have squeezed the bronchoscope in a vise

to create an oval tube-mouth. In other cases I have used expanding

forceps with grooved blades.

[FIG. 88.-Schema illustrating podalic version of bronchially-lodged

staples or double-pointed tacks. H, bronchoscope. A, swollen mucosa

covering points of staple. At E the staple has been manipulated upward

with bronchoscopic lip and hooks until the points are opposite the

branch bronchial orifices, B, C. Traction being made in the direction

of the dart (F), by means of the rotation forceps, and counterpressure

being made with the bronchoscopic lip on the points of the staple, the

points enter the branch bronchi and permit the staple to be turned

over and removed with points trailing harmlessly behind (K).]