Dear Fiction Dr.,

I have a character who is a female journalist injured in Iraq, probably by a roadside bomb. My question is about shrapnel left in the body. I understand that it can exit the body for years after the injury has essentially healed. What pushes it out? Movement maybe? Or heat from a warm shower? Would pulling it out feel like extracting a splinter? Does the exit site bleed? And, pragmatic everyday issues, like, if it’s in her legs, will she be able to shave her legs?

Thanks,
Rhonda

---

Dear Rhonda,

Surgically removing shrapnel, fragments of metal from a bomb, can cause more harm than leaving them alone. If the metal fragments are not close to critical organs, they should not be excised. If they are in bone, the chest cavity, or the spinal column, they will usually not move. If the fragments are near the skin surface or in a large muscle that can push them to the surface, they will be extruded.

Most victims injured by shrapnel will carry the fragments for decades. Here is an article describing the extrusion of a metal fragment from the face of a man sixty years after a hand grenade injured him. (He developed a small inflamed nodule on his chin—it contained a 4 mm metallic fragment.)

Here is a photo of a victim with healed shrapnel wounds to the face. It appears that he can shave without a problem as long as none of the fragments are close to the surface.

Sometimes when shrapnel is extruded it can create a sinus tract that gets infected and drains. But, the fragment may also be extruded with very little problem. Here is a personal report from an Internet blog of a victim removing shrapnel without obvious discomfort:

“Today I saw a man pick out a small shard of shrapnel from his skin that had worked its way out from deeper tissue. The wound was months old. He did it without veering off topic or changing the rate or rhythm of his speech. Without even wincing, he picked at his skin for a few moments and then teased out a piece of metal. He then placed it on the table next to us as we finished our conversation. No further discussion on the metaphor is required.”

Hope that helps!

Best Regards,

Dr. Karen

 

« go back