Alternate Nail Cleaners

We read this Technical Tip with interest and tried it out but would like to express concerns regarding the use of plastic nail cleaners. Different types of nail cleaners are available (Fig. 1, left [Laboratories Pharmaceutiques Vygon, 5A 11 Reuadeline, 95440 Ecouen, France] and middle [Becton Dickinson, Franklin Lahes, NJ 07417-1884, USA]) and it was not specified which one to use. We tried using the one on the left in the figure and failed to prise the nail from its bed. The pointed end cannot be used and so faces the surgeon's hand putting the surgeon at risk of self-harm if it slips during the procedure. The length of the plastic cleaner does not give an adequate lever arm. This combined with the fact that it is malleable makes the procedure difficult and the sharp tip can cause injury to the surgeon. Lastly, although the plastic cleaners come with a surgical hand-brush impregnated with a solution of chlorhexidine or PVP iodine, they are not sterile. For these reasons we do not recommend the cleaner found in hand-scrubbing packs for prising the nail. We routinely use the McDonald dissector (Fig. 1, top) for the above procedure. A long lever arm and blunt ends make it a very safe and easy to use instrument.

Figure 1.

Nail cleaners