What are clinical pearls 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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When using cautery or a heated paper clip, apply gentle pressure with repeated, quick motions until blood drainage is observed. Applying prolonged constant pressure with heat can result in pain and/or burns.

When appropriate, take a radiograph of the finger to rule out an underlying fracture that may require splinting.

Always check for the presence of an associated extensor tendon injury.

Hematomas that are larger than 50% of the nail do not necessarily require nail removal and exploration. [7, 13]

The nail may fall off during the week following hematoma drainage but should regrow as long as the germinal matrix is intact. [14]

Multiple holes may be necessary to facilitate adequate drainage.

Drainage of the subungual hematoma does not accelerate healing or prevent infection.

If the heat of an electrocautery device is painful for the patient (which is not typical), an 18-ga needle should instead be used for trephination.

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