Foreign bodies, mostly wooden splinters, often become deeply wedged under fingernails and toenails (Fig. 8.1a). Efforts by patients to remove the splinters often aggravate the problem. Methods of effective removal are outlined here.
Shows: (a) splinter under nail; (b) V-shaped incision; (c) tug with forceps
Take a sterile hypodermic needle, or any household needle that can be sterilised in a gas jet flame, and insert it just underneath the splinter, parallel to the nail through the entry tract. Then push the protruding end of the needle downwards. Since the needle spears the splinter, the lever effect drags out the splinter.
Perform a digital nerve block to anaesthetise the involved digit (may not be necessary in rugged individuals).
Using small but strong scissors, cut a V-shaped piece of nail from over the end of the splinter (Fig. 8.1b). It is important to leave sufficient splinter exposed so that a good grip can be obtained. (A poor grip can result in fragmentation of the splinter.)
Obtain a good grip on the end of the splinter with the splinter or small-artery forceps, and remove with a sharp tug in the axis of the finger (Fig. 8.1c).
Use a no. 15 scalpel blade to gradually pare the nail overlying the splinter to create a window so that the splinter can be lifted out (Fig. 8.2). This is painless since the nail itself has no innervation.
Method of paring over a nail splinter using light shaving strokes
Onychogryphosis, or irregular thickening and overgrowth of the nail, is commonly seen in the big toenails of the elderly (Fig. 8.3). It is really a permanent condition. Simple removal of the nail by avulsion is followed by recurrence some months later. Softening and burring of the nail gives only temporary relief, although burring sometimes provides a good result. The powder from burring can be used as culture for fungal organisms.
Adapted from A. Forrest et al., Principles and Practice of Surgery, Churchill Livingstone, Edinburgh, 1985, with permission.
Permanent cure requires ablation of the nail bed after removal of the nail. Two methods of nail bed ablation are: