Do You Have to Drain a Subungual Hematoma?

A subungual hematoma is a collection of blood underneath the nail (in the nail bed) caused by nail injuries. The injuries rupture the capillaries and cause leakage of the blood under the nail bed. These injuries can be due to

• Fall of a heavy object on the finger or toe
• The finger or toe getting hit by an object, such as a hammer
• The finger or toe getting slammed in a house door

Runner’s toe is a good example of a subungual hematoma. A runner’s toe is a condition that commonly occurs in marathon runners due to the slamming of the toes against the shoes while running.

A subungual hematoma is easy to identify by its appearance. Its signs and symptoms include

• Red, maroon or purplish color of the nail bed that changes to dark brown and then black
• Throbbing pain due to pressure of the collected blood on the nail bed
• The nail becomes sore or painful to the touch
• The pain usually resolves a few days after the injury

Treating a subungual hematoma at home is simple. Here is what you can do

• Keep the affected hand or foot elevated (reduces the swelling).
• Apply ice wrapped in a cloth over the affected finger/toe.
• Compress the nail by wrapping a tight bandage around it (reduces the bleeding).
• Take over-the-counter analgesics to relieve the pain.

Sometimes, a subungual hematoma may not get resolved with home treatment. You need to seek medical treatment if

• The bleeding does not stop
• The pain worsens
• The nail bed has been severely damaged

If your wound is very deep or there are lacerations in the surrounding skin of the subungual hematoma, your doctor may suture the wound. They may also ask for an X-ray to check if there are any broken bones in the finger or toe.

The procedure to drain a subungual hematoma is known as trephination. This is done by using a sharp instrument to pierce the nail. Multiple holes may be made to facilitate adequate drainage.

Before the procedure, the doctor will apply an antiseptic solution, such as Povidone-iodine over the nail. They may numb the area to be drained by injecting local anesthetic medicine. The drainage can be done by any of the techniques mentioned below

• Needle: A medical needle is used to make a hole in the nail.
• Electrocautery: A heated wire is pressed on the nail to penetrate the nail.
• Paper clip: The sharp end of the paper clip is heated and pressed on the nail to pierce it.

Next, the doctor will apply an antibiotic cream over the nail and cover it with a small bandage. Splinting may be done in case there is a fracture.

It is necessary to keep the splint and the wound dry.

The nail may fall off during the week after the hematoma drainage but will regrow in 8 weeks (fingernail) to 6 months (toenail). It may take longer if the nail bed has been severely damaged.

A subungual hematoma usually resolves on its own without any treatment. The discoloration disappears as the nail grows. Over several months, a new nail eventually grows to replace the damaged nail.

• After the subungual hematoma, the nail may even fall off followed by nail regrowth.
• Remember that you may get a permanent nail deformity despite seeing and receiving treatment from your doctor.