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Am Fam Physician. 2004;69(11):2525

to the editor: In the June 15, 2003, issue of American Family Physician, Drs. Chan and Salam discuss an operative technique for the removal of subungual slivers.1 I would like to suggest an alternative method, which is to treat the patient conservatively. If the physician cannot remove the sliver easily with an approach under the nail (i.e., using a hooked 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” out with the nail and can be removed easily in 10 to 14 days.

In 20 years of using this technique, I have never seen a subsequent deformity or infection of the nail. The patient is happier with the results because he or she does not have a “split” nail while the débrided nail heals. The initial pain seems to clear rapidly and can be handled with analgesic medications.

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This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

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