The removal of all jewelry and piercings is a mandatory protocol before undergoing any surgical procedure. This universal requirement is based on safety concerns that metal objects introduce into the highly controlled surgical environment. These precautions are designed to safeguard the patient during a period of maximum vulnerability. The necessity for removal applies even to piercings located far from the actual surgical site, establishing a non-negotiable standard of care.
Preventing Electrical Burns During Surgery
The most significant safety justification for removing metal piercings involves the routine use of electrosurgery, a technique that uses high-frequency electrical current to cut tissue and control bleeding. This process, often called electrocautery or diathermy, relies on a carefully managed electrical circuit that passes through the patient’s body. The circuit is designed to exit the patient safely through a return electrode, commonly referred to as a grounding pad.
A metal piercing can act as an unintended alternate pathway for this electrical current, especially if the return electrode contact is compromised. When the high-frequency current encounters a small surface area like a piercing, the current density increases dramatically. This intense concentration of electrical energy rapidly generates heat, which can lead to severe localized thermal burns at the piercing site.
This risk applies even if the piercing is not near the surgeon’s working area, as the electrical current seeks any available conductive path. These burns are often deep and can result from the metal becoming superheated or from an electrical arc. Covering the piercing with tape is insufficient, as it does not prevent the metal from conducting electricity or causing a burn.
Risks of Infection and Tissue Swelling
Piercings introduce two biological risks heightened during surgery: infection and post-operative tissue damage. Metal jewelry, particularly complex designs, can harbor colonies of bacteria known as biofilm. This microbial community is resistant to standard topical skin preparation solutions used in the operating room.
Introducing this reservoir of bacteria near a fresh incision poses a substantial risk of Surgical Site Infection (SSI). Biofilm-associated SSIs are difficult to treat because the protected bacteria are tolerant to conventional antibiotics. Removing the jewelry eliminates a potential source of contamination that could lead to a serious post-operative infection.
The second concern relates to localized swelling, or edema, which often follows surgical trauma and anesthesia. Metal jewelry is rigid and cannot expand, meaning rapid tissue swelling around a piercing can constrict the tissue, leading to localized ischemia. This restriction of blood flow can cause tissue death, known as necrosis, or require the emergency cutting of the jewelry to relieve pressure. This risk is high with piercings in areas prone to swelling, such as the tongue or cartilage.
Interference with Imaging and Airway Management
Piercings create practical complications that compromise both diagnosis and airway safety. Metal jewelry, especially ferromagnetic components, creates severe artifacts on essential medical imaging like X-rays, Computed Tomography (CT), or Magnetic Resonance Imaging (MRI). These artifacts appear as streaks or distortions that can completely obscure critical anatomical structures or the surgical target.
The presence of metal can make it impossible for surgeons and radiologists to visualize the necessary area, potentially leading to errors or delays. During an MRI, strong magnetic fields can cause ferromagnetic jewelry to move, potentially tearing tissue, or induce heating that results in thermal burns. Even non-ferromagnetic metals can heat up due to the powerful radiofrequency fields used in scanning.
Oral and facial piercings present a direct threat to successful airway management under general anesthesia. Piercings, particularly tongue bars, can physically obstruct the placement of airway devices like a laryngoscope or an endotracheal tube. If the jewelry is accidentally dislodged during the procedure, there is a significant risk of the patient aspirating or swallowing the hardware while unconscious.