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Subungual Hematoma (Bleeding Under the Nail)

Treatment of an Uncomplicated Subungual Hematoma

A painless and small subungual hematoma usually requires no treatment. However, the pressure generated by pooled blood under the nail can be extremely painful. To relieve the pain, your health care provider may perform decompression, also called trephination, which allows the underlying blood to drain, relieving pressure and pain to the area. 

After numbing the affected finger or toe with a nerve block, your health care provider may use one of the following decompression methods to drain the subungual hematoma:

  • Cautery. A heated wire (electrocautery device) is used to burn the hole or holes. This is a quick and painless procedure.
  • Paper-clip method. A heated paper clip is placed over the center of the hematoma to melt a hole into the nail.
  • Needle. A large-diameter needle is used to perforate the nail.

During the cautery and paper-clip procedures, the heated tip is cooled by contact with the hematoma, which prevents injury to the nail bed.

After a decompression procedure,your nail will be bandaged. You will need to keep the finger or toe bandaged and elevated -- and use cold compresses, if necessary -- during the first 12 hours following decompression. In some cases, your health care provider may recommend you use a splint for as long as three days until the tenderness subsides.

The main complication associated with decompression is a small risk of infection in the residual hematoma.

Treatment of a Complicated Subungual Hematoma

If a subungual hematoma affects at least 50% of the nail surface, the nail bed is likely to have significant injury. In these cases, nail removal may be necessary, along with stitches to the nail bed.

Resolution of a Subungual Hematoma

Unless a subungual hematoma is very small, an affected nail will usually fall off on its own after several weeks because the pooled blood has separated it from its bed. A new fingernail can regrow in as little as eight weeks while a new toenail may not fully regrow until about six months. If there has been injury to the nail bed and/or surrounding tissues, regrowth may be delayed.

Even with the best repair, there is still a possibility that the new nail may grow back with an abnormal appearance. See your health care provider if you notice any problems with the nail as it heals and regrows.

WebMD Medical Reference

Reviewed by Melinda Ratini, DO, MS on March 26, 2013
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