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.
