Where do you nail trephination?
Where do you nail trephination?
Trephination of a subungual hematoma consists of placing one or more holes in the nail to permit drainage of blood. Subungual hematoma (blood under the fingernail or toenail), a common childhood injury, is usually caused by a blow to the distal phalanx (eg, crush in a door jamb, stubbing one’s toe).
Is nail trephination painful?
Most subungual hematomas can be relieved with simple trephination, a procedure which involves making a small hole in the nail. Unless the pressure is relieved, the patient may experience severe pain.
What happens if you don’t drain a subungual hematoma?
If left untreated, a simple subungual hematoma typically grows out along with the lengthening nail plate and resolves on its own. Until the nail grows out, however, you can expect weeks to months of blue-black discoloration.
How do you uncompress a subungual hematoma?
The treatment of a simple subungual hematoma requires subungual decompression, which is usually achieved by creating small holes in the nail plate. Draining the blood from the nail plate with an 18-gauge needle is significantly less painful than 1 injection of digital nerve block.
How do you perform trephination?
One of the techniques most commonly taught to new practitioners is to employ heat to melt a hole in the nail. A heated paper-clip tip or a portable medical electrocautery unit may be used (Figure 2). Some clinicians feel that trephination accomplished through the use of heat is more painful than other methods.
How do you take care of your nails after trephination?
Aftercare
- Dress with sterile gauze. Inform the patient that drainage through the hole may continue for 24 to 36 hours.
- Return of pain may indicate a trephination site clot. A warm soak can help remove the clot and relieve pain.
- Prophylactic antibiotics are not routinely needed even if a fracture is present.
When is it too late to drain a hematoma?
Subungual hematomas should be trephinated if they are acute (less than 24 to 48 hours old), are not spontaneously draining, are associated with intact nail folds, or are painful. After 48 hours, most subungual hematomas have clotted and trephination is typically not effective.
Can I drain my own hematoma?
If blood is spontaneously draining from the hematoma, drainage of subungual hematoma is generally not required. You should not try draining your subungual hematoma at home as improper drainage may result in infections or permanent damage to the nail bed. A subungual hematoma is sometimes drained by a doctor.
How long does a nail hematoma take to heal?
A minor subungual hematoma usually heals over time without treatment. The trapped blood will eventually be reabsorbed, and the dark mark will disappear. This can take 2–3 months for a fingernail, and up to 9 months for a toenail.
Why was trephination done?
Why did people do it? In ancient times, trepanation was thought to be a treatment for various ailments, such as head injuries. It may also have been used to treat pain. Some scientists also think that the practice was used to pull spirits from the body in rituals.
