Delayed reaction to shrapnel retained in soft tissue

Background: Treatment of penetrating injuries to soft tissues does not require surgical excision of shrapnel. Metals usually remain inert and do not cause damage and are therefore left in soft tissue. Objective: Characterization of delayed reaction to shrapnel retained for many years in soft tissue. Patients: Four patients sustained penetrating injuries to the limbs with embedded shrapnel. Many years later, they experienced delayed reaction to the metals that required surgery, with very unusual findings. Conclusions: Although nonsurgical treatment of shrapnel in soft tissues is the treatment of choice in most cases, we need to be aware of the possibility of late complications requiring surgical treatment. (C) 2004 Elsevier Ltd. All rights reserved.