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Instrument and technique for removal of subungual foreign bodies
MODERN OPERATIVE TECHNIQUE
Instrument and Technique for Removal of Subungual Foreign Bodies Carl H. Andrus, MD, Rochester, New York
A foreign body lying deep to the fingernail is a tender and delicate problem. Treatment usually requires digital block anesthesia, and removal of the nail is often necessary before the foreign body can be retrieved. The author has used a simpler approach that works quite satisfactorily in certain circumstances and is completely painless. An 18 gauge disposable needle makes an effective and easily controlled microblade. There is a cutting edge on both sides of its point. It is not as sharp as a scalpel. These properties can be used advantageously to window the nail, as exemplified by the following cases. Case Reports Case I. A 48 year old secretary was injured when she passed through a machine shop and a minute fragment of steel penetrated the nail of her right long finger at the junction of the proximal and middle thirds. Forty eight hours after injury she complained of pain and slight swelling of the distal phalanx. There was a 3 by 3 mm abscess visible through the nail and surrounding the defect of entry. After preparation with alcohol and without anesthesia, a 2 mm window was cut with the point of an 18 gauge disposable needle around the point of entry, as shown in Figure 1. The foreign body was lifted out with the window and the abscess drained. No defect was visible in the nail after it had grown out. Case II. A 23 year old student noted pain in his right index finger and found that he had driven a length of mechanical pencil lead under the nail of the finger. The lead had broken off, leaving a residual fragment 3 mm long that was clearly visible where it lay longitudinally across the junction of the proximal and middle thirds of the nail. It was clear from examination that the foreign body had opened the plane between the nail and the nail bed. There was no bleeding. The fragment was beyond reach of splinter forceps. After alcohol preparation and without anesthesia, a 2 by 3 mm window was cut in the nail and the underlying foreign body was lifted out with fine forceps. Nail growth was unimpaired, and the nail looked perfectly normal when the window had grown out completely. f=romtheDeparMMofStrgsry,Universltyof FWxhe&rSchoolofMedicirm and Dentistry, Root-ester, New York. Requests for reprints should be addressed to Carl H. Andrus. MD, Department of Surgery, Strong Memorial Hospital, 601 Elmwood Avenue, Rochester, New York 14842.
Comments This technique is feasible only when the nail and its bed are separated by fluid as in case I or mechanically as in case II. Prior dissection of the nail away from its bed by the pathologic process allows room to incise the nail without causing pain due to injury of the underlying tissue. Anesthesia is therefore not required. The dullness of the needle compared with a scalpel is advantageous. The needle is more easily controlled because it seems to split the nail slightly ahead of itself and so is not gripped by the nail. If this technique is used in the proximal third of the finger nail, care must be taken to avoid injury to the nail matrix, which can be identified by the semilunar line. Summary An 18 gauge needle is an effective instrument for transungual removal of foreign bodies when the nail has been separated from its bed sufficiently to allow windowing of the nail without injury to the underlying tissue.
Figure 1. Case I. A window has been Incised In the nali
aroad the tore&yn body and over the abscess. 77~ tourth
shle was cut with sc!ssors and the square Ilftuf away.
TheAmerican
Journal d Suurguy
Instrument and Technique for Removal of Subungual Foreign Bodies Carl H. Andrus, MD, Rochester, New York
A foreign body lying deep to the fingernail is a tender and delicate problem. Treatment usually requires digital block anesthesia, and removal of the nail is often necessary before the foreign body can be retrieved. The author has used a simpler approach that works quite satisfactorily in certain circumstances and is completely painless. An 18 gauge disposable needle makes an effective and easily controlled microblade. There is a cutting edge on both sides of its point. It is not as sharp as a scalpel. These properties can be used advantageously to window the nail, as exemplified by the following cases. Case Reports Case I. A 48 year old secretary was injured when she passed through a machine shop and a minute fragment of steel penetrated the nail of her right long finger at the junction of the proximal and middle thirds. Forty eight hours after injury she complained of pain and slight swelling of the distal phalanx. There was a 3 by 3 mm abscess visible through the nail and surrounding the defect of entry. After preparation with alcohol and without anesthesia, a 2 mm window was cut with the point of an 18 gauge disposable needle around the point of entry, as shown in Figure 1. The foreign body was lifted out with the window and the abscess drained. No defect was visible in the nail after it had grown out. Case II. A 23 year old student noted pain in his right index finger and found that he had driven a length of mechanical pencil lead under the nail of the finger. The lead had broken off, leaving a residual fragment 3 mm long that was clearly visible where it lay longitudinally across the junction of the proximal and middle thirds of the nail. It was clear from examination that the foreign body had opened the plane between the nail and the nail bed. There was no bleeding. The fragment was beyond reach of splinter forceps. After alcohol preparation and without anesthesia, a 2 by 3 mm window was cut in the nail and the underlying foreign body was lifted out with fine forceps. Nail growth was unimpaired, and the nail looked perfectly normal when the window had grown out completely. f=romtheDeparMMofStrgsry,Universltyof FWxhe&rSchoolofMedicirm and Dentistry, Root-ester, New York. Requests for reprints should be addressed to Carl H. Andrus. MD, Department of Surgery, Strong Memorial Hospital, 601 Elmwood Avenue, Rochester, New York 14842.
Comments This technique is feasible only when the nail and its bed are separated by fluid as in case I or mechanically as in case II. Prior dissection of the nail away from its bed by the pathologic process allows room to incise the nail without causing pain due to injury of the underlying tissue. Anesthesia is therefore not required. The dullness of the needle compared with a scalpel is advantageous. The needle is more easily controlled because it seems to split the nail slightly ahead of itself and so is not gripped by the nail. If this technique is used in the proximal third of the finger nail, care must be taken to avoid injury to the nail matrix, which can be identified by the semilunar line. Summary An 18 gauge needle is an effective instrument for transungual removal of foreign bodies when the nail has been separated from its bed sufficiently to allow windowing of the nail without injury to the underlying tissue.
Figure 1. Case I. A window has been Incised In the nali
aroad the tore&yn body and over the abscess. 77~ tourth
shle was cut with sc!ssors and the square Ilftuf away.
TheAmerican
Journal d Suurguy