What are the contraindications for subungual hematoma drainage?

Updated: Aug 25, 2020
  • Author: Oliver Mayorga, MD, MS, FACEP; Chief Editor: Erik D Schraga, MD  more...
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If nail removal is indicated to explore for complex nail bed lacerations (eg, if nail edges are disrupted with a deep laceration), subungual hematoma drainage is not indicated. Most simple nail bed lacerations, however, do not require nail removal and laceration repair. [7, 8]

Subungual hematoma drainage is not necessary if the hematoma is not painful. If blood is spontaneously draining from the hematoma, drainage is also unlikely to be of additional benefit.

In the presence of acrylic nails, electrocautery is contraindicated until the acrylic nail is removed. (Acrylic nails may be flammable, which is of concern if an electrocautery tool is used. [9] ) However, needle trephination can still be done if desired.

Of note, previous sources have recommended nail bed trephination only for subungual hematomas smaller than 25-50% of the nail surface. Recent studies have shown that hematoma size or the presence of underlying distal phalanx fractures do not result in a difference in complications. Therefore, nail bed trephination may be indicated for hematomas of any size if the nail edges are not disrupted. [10, 11, 12, 13]

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