11.07 Pencil Point Puncture

agk’s Library of Common Simple Emergencies

Presentation

The patient will tell you that he was stabbed or stuck with a sharp pencil point. He may be overtly or unconsciously worried about lead poisoning. A small puncture wound lined with graphite tattooing will be present The pencil tip may or may not be present, visible, or palpable If the puncture wound is palpated, an underlying pencil point may give the patient a foreign body sensation.

What to do:

• Reassure patient or parent that there is no danger of lead poisoning. Pencil “leads” are made of clay and graphite, which is carbon and non-toxic.
• Palpate and inspect for a foreign body. If uncertain, get an x ray, xerogram or ultrasound to rule out the presence of a foreign body.
• Scrub wound.
• Administer tetanus prophylaxis, if necessary.
• Warn the patient or family about signs of infection, and inform them that there will be a permanent black tattoo that can be removed later if the resulting mark is cosmetically unacceptable.

What not to do:

• Do not excise the entire wound on the initial visit.

Discussion

In order to reduce the amount of tattooing, the wound may be anesthetized and scraped (dermabraded) with the tip of a scalpel blade. It is unwise to excise the entire wound because the resultant scar might be more unsightly than the tattoo. If a superficial pencil-tip foreign body exists, then see subcutaneous foreign body for an easy removal technique. Deep punctures and/or foreign bodies may require exploratory surgery in the operating room.

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