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Subungual Hematoma (Bleeding Under Nail) (cont.)

Treatment for Subungual Hematoma

  • Several techniques are used to drain the blood beneath the nail. This procedure is also called releasing the hematoma or trephination.
    • No single technique is preferred.
    • How your hematoma is drained depends on the experience of the doctor and where it is done.
  • Occasionally, the finger or toe is numbed with a digital block. (Your fingers and toes are called digits.) Some doctors (health care professionals) opt not to numb up the digits as the injection itself can cause as much if not more pain than the actual drainage of the hematoma.
    • A numbing medication such as lidocaine is injected at the bottom of your finger or toe.
    • Injecting the medication here numbs the entire digit.
    • As soon as your finger or toe is numb, the procedure can take place.
  • The following are commonly used methods for draining your hematoma:
    • Cautery: A battery-operated device is used to burn a hole in the nail until the blood is reached and drains out of the hole. This technique should not be used if the patient is wearing artificial acrylic nails which might be flammable.
    • Needle: A large diameter needle is used to drill or bore into the nail to create a hole to allow the blood to drain out.
    • Paper clip: This technique, although an older one, is still used by some practitioners. A paper clip is opened so that the pointed end is free. Then the pointed end is heated up, usually by passing it through a flame, and used to burn through the nail. This technique uses a combination of the cautery method and the needle method.

Subungual Hematoma Follow-up

  • After the subungual hematoma has been drained, follow-up is usually not necessary.
  • Antibiotics are not routinely needed after a subungual hematoma is drained.
  • If the nail was removed and a cut in your nail bed was stitched closed, you should see your doctor in 48-72 hours for re-examination.
    • Usually, the type of sutures (stitches) placed will dissolve, so removal is not needed.
    • If non-dissolvable sutures (nylon) are placed in a nail bed laceration, they need to be removed in about seven days in the emergency department or by your doctor.
    • Close monitoring is still recommended.

Subungual Hematoma Prevention

Use common sense and practice other safety-minded actions to prevent getting your fingers slammed in doors or dropping heavy objects on your toes.

  • Steel-toed shoes are important safety equipment to wear on certain high-risk jobs such as construction.
  • Watch children's hands as you open and close car doors.
  • Give your full attention to the task at hand. Finger injuries often happen when the person using the tool is distracted.
  • Don't lift something you cannot handle alone. Find people to help you carry heavy objects to avoid dropping them on your toes.
Medically Reviewed by a Doctor on 5/18/2016
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