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10.09 Foreign Body Beneath Nail


Presentation

The patient complains of a paint chip or sliver under the nail. often he has unsuccessfully attempted to remove the foreign body, which will be visible beneath the nail.

What to do (Paint Chip):

What to do (Sliver):

What not to do:

Discussion:

It is often not possible to remove a long sliver from beneath the fingernail using the "shaving" technique with a scapel blade, without injuring the nailbed, and causing the patient considerable discomfort. After providing a digital block, it is sometimes possible to remove the sliver by surrounding it with a hemostat that has been slipped between the nail and nailbed and then pulling out the entire sliver, but if any debris remains visible, then the overlying nail wedge should be removed so the nailbed can be thoroughly cleansed. It is usually unwise simply to attempt to pull the foreign body from beneath the nail because some debris usually remains and will most likely lead to a nailbed infection.

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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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