TO THE EDITOR: In the June 15 2003 ...

TO THE EDITOR: In the June 15 2003 issue of American Family Physician, Dr Chan and Salam discuss an operative technique for the removal of subungual slivers. (1) I would like to propose an alternative method, which is to treat the patient conservatively. If the physician cannot dislodge the sliver easily with an approach subordinate to the nail (i.e., using a grasshooked needle or forceps), the sliver may be left where it is. The patient should receive tetanus toxoid and antibiotics, if necessary. The sliver will gradually "grow" revealed with the nail and can be remov easily in 10 to 14 days.

In 20 years of using this technique, I have not seen a subsequent deformity or infection of the nail. The patient is happier with the be the effects because he or she does not have a "split" nail while the debrided nail heals. The initial pain appears to clear rapidly and can be handled with analgesic medications.

REFERENCE

(1) Chan C Salam GA. Splinter removal. Am Fam Physician 2003;67:2557-62

ROBERT KAYE, MD

Samaritan North Lincoln Hospital Clinic

825 NW Hwy 101

Lincoln City, OR 97367

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