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):
Without anesthesia, remove the overlying nail by shaving it off
with a #15 scalpel blade.
Cleanse remaining debris with normal saline and trim the
nail edges smooth with scissors.
Provide tetanus prophylaxis if necessary and then dress the
area with antibiotic ointment and a bandage.
What to do (Sliver):
If the patient is cooperative and can tolerate some
discomfort, carve through the nail down to the perimeter
of the sliver with a #11 blade until the overlying nail
falls away. The foreign body can now be cleansed away,
antibiotic ointment can be applied to the exposed nailbed,
and a Band-Aid dressing can be applied.
For a more extensive excision of a nail wedge, you will
need to perform a digital block.
Slide small Mayo or iris scissors between the nail and nailbed on
both sides of the sliver and cut out the overlying wedge
of nail.
Cleanse any remaining debris with normal saline and trim
the fingernail until the corners are smooth.
Dress with antibiotic ointment and a bandage. Have the
patient redress the area 2-3 times daily until healed, and
keep the fingernail trimmed close.
What not to do:
Do not run the tip of the scissors into the nail bed while
sliding it under the fingernail (instead angle the tip up into
undersurface of the nail).
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.
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.
