Nothing bothers you
The fragment is visible only in the picture, but it does not hurt and does not interfere.
CONDITION / FACE
Splinters and foreign bodies in the face and neck.
Shrapnel in the face and neck are fragments of shells, bullets, glass, wood, or other materials left in the skin and soft tissues after an injury. Not every fragment needs to be removed: the decision is made after examination and CT, weighing the benefits and risks of the operation.
CONCEPTUAL VISUALIZATION- What it is
- Fragments of shells, bullets, glass, wood or plastic left in the soft tissues of the face and neck.
- To take out
- Not always: the decision is based on the material, location and symptoms, after examination and CT scan.
- MRI
- In the case of metal fragments, MRI is performed only after a risk assessment by a radiologist; debris is searched for on CT.
- Who treats it
- Surgeon; if the fragment is near the eye, together with an ophthalmologist.
01 / WHAT IS ITWhat is
What is
foreign bodies in tissues.
A foreign body is everything that entered the tissues from the outside and remained there. After injuries, these are fragments of shells and mines, parts of bullets, as well as glass, wood, pebbles or plastic, which are driven into the wound by an explosion or impact. Most often, glass, metal and wood are found in wounds.
The body tries to isolate the foreign object: inflammatory tissue forms around it. Part of the debris does not bother. Others cause infection—most often complications—long-term pain or pressure on nerves and blood vessels.
Therefore, the main question is not "how to get everything", but "what exactly should be deleted". On the face, a wide search for a fragment through a large incision is undesirable: facial expressions, nerves and appearance are important here.
This is general information. The doctor will tell you what will suit you after the examination.
02 / SIGNSHow they give about themselves
How they give about themselves
know the debris.
Complications from fragments are early and late: the fragment may not bother you for a long time, and then catch fire.
Tightness and pain
It feels hard under the skin, hurts when touching, chewing or turning the head.
Inflammation
Redness, swelling, pus, a wound or scar that reopens. Infection is most often a complication of foreign bodies.
Fire woundNumbness or weakness
Fragment near the nerve: part of the face is numb or moves less.
Paralysis of the facial nerveNear the eye
Pain, bulging of the eye, new double or blurred vision. If it appeared suddenly or after a fresh injury, call 103; the fragment in the orbit is evaluated together with an ophthalmologist.
Injuries of the orbitScars
After the injury, scars remained with the fragments under them; the scar tightens the skin or hurts.
Scars after facial injuries03 / REASONSWhere do they come from?
Where do they come from?
debris
The material of the fragment depends on whether it is visible on the picture, how prone it is to infection and whether MRI is safe.
Explosions
Fragments of shells, mines and drones. In a study of 53 wounded from the war in Ukraine, who were treated in Spain, 83% were affected by the explosion.
Bullets
Bullet fragments may contain lead, and some military bullets may contain steel or nickel.
Glass, wood, plastic
These fragments are often missed during examination and on a conventional X-ray; wood and plastic X-ray may not show at all.
Contaminated wound
In a study of war wounded in Ukraine, wound infection was associated with the presence of foreign bodies, bone damage, and skin defect.
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
An old wreck that does not bother you is a planned situation, it usually does not need emergency help. But a fresh wound on the neck or face can be dangerous: the neck is close to large blood vessels and airways.
103 immediately if:
- bleeding from a wound on the face or neck does not stop, despite pressing;
- blood beats in a stream;
- swelling or pulsating swelling on the neck grows rapidly;
- it is difficult to breathe or breathing is very frequent;
- confusion or slurred speech;
- blue, pale, or mottled skin or lips;
- suddenly worsened or disappeared vision;
- pain in the eye, bulging of the eye or new double vision appeared after the injury;
- air bubbles come out of the wound;
- vomiting blood;
- sudden weakness or numbness in an arm or leg;
- a fresh neck wound from a shrapnel, bullet or glass - even if the blood is almost not flowing;
- a large or deep fresh wound on the face;
- an object is stuck in the wound - do not remove it yourself and do not press on it.
Do not delay a visit to the doctor:
On the same day: the skin around the fragment is reddened, swollen, hurts more and more, or pus flows from the wound; you feel unwell or have a fever; earth or dirt in the wound that does not wash out; the eye near the old fragment is reddened or vision is gradually deteriorating - see an ophthalmologist. If the wound is fresh, the doctor will also check the tetanus vaccination. Planned: the fragment is felt under the skin, hurts, interferes, or just bothers you - see a CT surgeon to decide whether to remove it. If bullet fragments remain in the body, ask your doctor about a blood test for lead.
05 / DIAGNOSTICSHow to find
How to find
debris
- Conversation and documents
How and when the wounding occurred, whether the fragments were already removed, which is troubling now; statements and photographs, if available.
- Review
The surgeon evaluates scars, induration, signs of inflammation, facial expressions and sensitivity.
- CT
Basic examination: shows metal fragments, their size and distance to vessels, nerves and the eye. Without accurate pictures, the debris is not removed.
- ultrasound
Sees both metal and non-metal debris, if they lie shallow. According to a meta-analysis, ultrasound detects 72% of foreign bodies in soft tissues.
- MRI - with caution
Fragments with steel in the magnetic field can shift and damage nearby tissues, and the composition of the fragment is unknown. Therefore, MRI for metal fragments is performed only after a risk assessment by a radiologist, and CT is used to search for fragments. Before any MRI, be sure to tell about the debris.
06 / TREATMENTWhen the wreckage
When the wreckage
are removed
There are no single rules for which debris to remove. Decisions are made individually: some fragments can be left, but if the risk of complications is high, they are removed. The doctor discusses the benefits and risks of the operation with the patient.
01
Usually deleted
When the debris damages or may cause damage.
- Tree and plants
- Organic debris is prone to infection. For foreign bodies in orbit, removal is indicated for all organic debris.
- Inflammation and pain
- A fragment around which inflammation, pus or pain is removed; the wound is cleaned.
- Near the nerve
- The fragment presses on the nerve: part of the face becomes numb or moves worse.
- Shallow
- Surface debris is easier to get. In the orbit, inorganic fragments are advised to be removed if they lie anteriorly or cause complications.
02
You can observe
When the operation is more risky than the wreck itself.
- Deep without symptoms
- Metal or glass fragments that do not disturb and lie deep near important structures are sometimes left behind. In orbit, deep inorganic debris is advised not to be touched unless it causes complications.
- reviews
- Such debris is periodically inspected; if pain or inflammation appear, the decision is reviewed.
03
Fragments of bullets and lead
- risk
- Lead poisoning from bullets left in the body is rare but probably underestimated. The risk is higher with fractures, a large number of fragments and with time; it can be detected after months or years.
- Control
- According to a meta-analysis, with fractures or multiple fragments, blood lead levels are checked every 3 months during the first year. If it is higher than 5 μg/dL, the fragments are tried to be removed, unless it worsens the condition.
04
How to delete
- CT planning
- Without accurate visualization, the wreck is difficult to find. Removed through an existing wound or a separate incision.
- Navigation
- Computer-aided CT navigation shows the surgeon the position of the fragment during surgery. In a study on the bodies of donors with it, debris was found faster, and the incision was shorter — 10 mm versus 13 mm.
- What to expect
- Removal is also an operation: it is not always possible to find and retrieve the fragment, the surgeon warns about this in advance.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
Splinters and foreign bodies in the soft tissues of the face and neck are treated at Dr. Valikhnovskyi's Institute of Surgery in the direction of "Surgery for gunshot wounds." The clinic decides whether to remove the fragment and removes it; if the fragment is in the eye, it is treated by an ophthalmologist.
CLINIC SERVICE
Surgery of gunshot injuries
Bullet, shrapnel, and landmine injuries — from a fresh wound to restoration of tissue, form, and function.
View service
What we do for this condition
- Removal of foreign bodies — if the fragment hurts, causes an infection or lies next to the nerve; decision — after examination and CT scan.
- Removal of organic debris - fragments of wood, plants or plastic are usually removed: they cause infection.
- Follow-up — metal or glass fragments without symptoms near important structures are sometimes left and observed; debris near the vessels of the neck is removed only as indicated.
- Surgical treatment and closure of wounds — if the wound does not heal due to a fragment, the cause is first treated, then the wound is closed.
- Excision of scars — scars after injury are cut out and closed with local flaps.
- Lipofilling — own fat is injected into retracted areas and under scars.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How treatment works with us
- Photo onlineSend photos, CT scans and reports - the doctor will first assess where the debris lies.
- ConsultationExamination and CT scan, if it is not available or it is old; assessment of whether debris is in the way.
- PlanDelete or monitor; if removed - by what access and whether to correct the scar in the same operation.
- SurgeryRemoval of the fragment, treatment of the wound, if necessary, correction of the scar.
- Follow-upReviews after surgery; periodic control of the debris left behind.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
Do I need to remove all the shards?
No. Debris that hurts, causes infection, lies next to the nerve, as well as wood and plant fragments are removed. Deep metal fragments without symptoms are sometimes left and observed. The decision — after examination and CT.
Is it possible to do an MRI if there is a fragment in the face?
Only after a risk assessment by a radiologist: debris with steel in a magnetic field can shift, and the composition of the fragment is unknown. A CT scan is used to search for debris. Before any MRI, be sure to tell about the debris.
Is bullet lead dangerous?
Lead poisoning from bullet fragments is rare, but can take months or years to manifest. If there are several fragments or there is a fracture, the doctor may prescribe a blood test for lead.
Is a shrapnel in the neck near a vessel dangerous?
If the injury is fresh, call 103, even if the bleeding is almost nonexistent: the hospital will evaluate the condition with a CT scan with vascular contrast. If the fragment is old and does not bother you, the surgeon will tell you whether such a CT scan is necessary. Debris near vessels is removed only as indicated.
Can the splinter be removed through a small incision?
It depends on where the fragment lies. On the face, a wide search through a large incision is undesirable, so the fragment is first accurately found on CT, and access is chosen for each fragment separately.
Will there be a scar?
The scar from the incision always remains, but most scars lighten over time. If there are already rough scars after the injury, the surgeon will tell if they can be corrected during the same operation.
The shard didn't bother me, but now it caught fire. What to do?
See a surgeon the same day: infection is most often a complication of foreign bodies. Such a fragment is usually removed.
Sources
18 sources · reviews, meta-analyses, imaging guidelines and the NHSshowCollapse
- Clinical features and management of intraorbital foreign bodiesOphthalmology, 2002doi:10.1016/s0161-6420(01)00982-4 ↗
- Management of retained foreign bodies in missile injuries of the maxillofacial regionJournal of Craniofacial Surgery, 2011doi:10.1097/SCS.0b013e31821d17ee ↗
- Implementation of a miniaturised navigation system in head and neck surgery for the detection and removal of foreign bodiesEuropean Archives of Oto-Rhino-Laryngology, 2017doi:10.1007/s00405-016-4212-1 ↗
- Multimodality Imaging of Foreign Bodies: New Insights into Old ChallengesRadiographics, 2020doi:10.1148/rg.2020200061 ↗
- Diagnostic Accuracy of Ultrasonography in Retained Soft Tissue Foreign Bodies: A Systematic Review and Meta-analysisAcademic Emergency Medicine, 2015doi:10.1111/acem.12714 ↗
- Foreign Bodies in the Skin: Evaluation and ManagementAmerican Family Physician, 2020pubmed.ncbi.nlm.nih.gov/32538598 ↗
- MRI issues for ballistic objects: information obtained at 1.5-, 3- and 7-TeslaThe Spine Journal, 2013doi:10.1016/j.spinee.2013.02.068 ↗
- Magnetic Field Interactions of Military and Law Enforcement Bullets at 1.5 and 3 TeslaMilitary Medicine, 2016doi:10.7205/MILMED-D-15-00246 ↗
- What Radiologist Should Know about MRI Translational Forces and Hazard: An Ex-Vivo Simulation of Retained Metallic ShrapnelRadiology Research and Practice, 2021doi:10.1155/2021/6672617 ↗
- Retained bullets and lead toxicity: a systematic reviewClinical Toxicology, 2022doi:10.1080/15563650.2022.2116336 ↗
- Lead toxicity from retained bullet fragments: A systematic review and meta-analysisJournal of Trauma and Acute Care Surgery, 2019doi:10.1097/TA.0000000000002287 ↗
- Penetrating neck injuries: a guide to evaluation and managementAnnals of the Royal College of Surgeons of England, 2018doi:10.1308/rcsann.2017.0191 ↗
- Role of computed tomography angiography in the management of Zone II penetrating neck trauma in patients with clinical hard signsJournal of Trauma and Acute Care Surgery, 2015doi:10.1097/TA.0000000000000713 ↗
- ACR Appropriateness Criteria® Penetrating Neck InjuryJournal of the American College of Radiology, 2017doi:10.1016/j.jacr.2017.08.038 ↗
- Characterization of wound infections among patients injured during the Ruso-Ukrainian war in a Role 4 hospitalEnfermedades Infecciosas y Microbiología Clínica (English ed.), 2024doi:10.1016/j.eimce.2024.06.002 ↗
- Cuts and grazesNHS, 2026nhs.uk/conditions/cuts-and-grazes ↗
- SepsisNHS, 2026nhs.uk/conditions/sepsis ↗
- MRI scanNHS, 2025nhs.uk/tests-and-treatments/mri-scan ↗
The figures on the page are from these sources.
Debris remained
in the face or neck?
Send photos, CT scans and statements. The doctor will tell if the fragment should be removed and how to do it.