{"id":7203,"date":"2025-04-29T10:58:15","date_gmt":"2025-04-29T08:58:15","guid":{"rendered":"https:\/\/family-medicine.org\/subunguales-haematom\/"},"modified":"2025-04-29T19:48:21","modified_gmt":"2025-04-29T17:48:21","slug":"subunguales-haematom","status":"publish","type":"post","link":"https:\/\/family-medicine.org\/de\/subunguales-haematom\/","title":{"rendered":"Drainage eines subungualen H\u00e4matoms (evidenzbasiert)"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"7203\" class=\"elementor elementor-7203 elementor-7171\" data-elementor-post-type=\"post\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-1b6e058 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"1b6e058\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-71ddcbc\" data-id=\"71ddcbc\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-3bbeb3c elementor-widget elementor-widget-text-editor\" data-id=\"3bbeb3c\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Subunguale H\u00e4matome sind h\u00e4ufig. Hier ein essentieller Guide, wie und wann man sie entlastet:<\/p><h3>Trepanations-Indikationen<\/h3><p>Die <strong>Nageltrepanation<\/strong> (Aufbohrung) sollte bei subungualen H\u00e4matomen, die <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK482508\/\"><strong>schmerzhaft<\/strong><\/a> sind oder <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC10726102\/\"><strong>&gt;25%<\/strong><\/a> der Nagelfl\u00e4che bedecken und <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK482508\/\"><strong>&lt;48h<\/strong><\/a> alt sind angewendet werden. Sie lindert Schmerzen und verhindert Nageldystrophie und Sekund\u00e4rinfektionen (<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC10726102\/\">Quelle<\/a>).<\/p><h3>Nagelentfernungs-Indikationen<\/h3><p>Fr\u00fcher wurde bei gro\u00dfen H\u00e4matomen der Nagel entfernt, aber mehrere <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK482508\/\">Studien<\/a> zeigten, dass die Trepanation <strong>ebenso wirksam<\/strong> ist. Heute wird sie nur noch bei Nagelabriss, proximalen Frakturen oder dislozierten distalen Frakturen empfohlen.<\/p><h3>H\u00e4matom-Diagnose<\/h3><p><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7507148\/\">Typisch<\/a> sind pl\u00f6tzliche Schmerzen nach einem Nageltrauma und scharfkantige Farbver\u00e4nderungen, die sich distal ausbreiten. DD: subunguales <strong>Melanom<\/strong>.<\/p><h3>Weitere Untersuchungen<\/h3><p>Ein <strong>R\u00f6ntgen<\/strong> kann notwendig sein, da Frakturen h\u00e4ufig sind. <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK482508\/\">Frakturen<\/a> erfordern Antibiotika (es sind im Grunde offene Frakturen), sind aber keine Kontraindikation f\u00fcr die Trepanation.<\/p><h3>Vorbereitung<\/h3><p><strong>Reinige<\/strong> und<strong> desinfiziere<\/strong> gr\u00fcndlich. Manche <a href=\"https:\/\/evolve.elsevier.com\/cs\/product\/9780323476331\">Quellen<\/a> empfehlen eine digitale Blockade mit Lidocain, w\u00e4hrend <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK482508\/\">andere<\/a> meinen, sie sei schmerzhafter als der Eingriff selbst. Verwende einen Schutz, da Blut spritzen kann.<\/p><h3>Instrumente &amp; Methode<\/h3><p><a href=\"https:\/\/evolve.elsevier.com\/cs\/product\/9780323476331\">Pfenninger &amp; Fowler\u2019s<\/a>, <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK482508\/\">StatPearls<\/a>, <a href=\"https:\/\/shop.thieme.de\/PraxisSkills-Allgemeinmedizin\/9783132424012\">PraxisSkills<\/a> und <a href=\"https:\/\/www.jaad.org\/article\/S0190-9622(20)30484-9\/\">JAAD<\/a> bevorzugen jeweils eine dieser Methoden:<\/p><ul><li><strong>Bohren<\/strong>: Drehe eine Nadel oder ein Skalpell zwischen deinen Fingern.<\/li><li><strong>Elektrokauter<\/strong>: Verwende die Kauterspitze, bis ein Loch entsteht.<\/li><li><strong>B\u00fcroklammer<\/strong>: Erhitze sie \u00fcber einer offenen Flamme, bis sie rot gl\u00fcht. Dann dr\u00fccke fest an, aber nur bis zur Perforation, um das Nagelbett zu sch\u00fctzen.<\/li><li><strong>Biopsie-Stanze<\/strong>: Perforiere den Nagel mit einem Biopsie-Stanz-Instrument oder einer K\u00fcrette.<\/li><li>Hier sind <strong>kurze Videos<\/strong> zur Trepanation mit <a href=\"https:\/\/www.youtube.com\/watch?v=G_7eKSYLfxY\"><strong>Elektrokauter<\/strong><\/a> sowie einer <a href=\"https:\/\/www.youtube.com\/watch?v=rT9SRN3F5Hw\"><strong>Nadel<\/strong><\/a>.<\/li><\/ul><h3>Komplikationen<\/h3><p>Verlust des Nagels (vor\u00fcbergehend), H\u00e4matomrezidiv (h\u00e4ufig), Infektion, Schmerzen und nicht erkannte Frakturen.<\/p><h3><span style=\"text-decoration: underline;\">Conclusio<\/span><\/h3><ul><li>Mach das Loch <strong>1-2mm breit<\/strong>, um zu verhindern, dass es sich innerhalb von Stunden wieder verschlie\u00dft.<\/li><li>Trage eine <strong>antibiotische Salbe<\/strong> auf, um Infektionen zu verhindern und auch um Blutgerinnung zu vermeiden.<\/li><li>Vermeide pl\u00f6tzliche Bewegungen bei Kindern und \u00e4ngstlichen Patienten, indem du <strong>unsichtbar<\/strong> arbeitest (durch die Fasern einer Mullbinde).<\/li><li><strong>Erhalte<\/strong> den Nagel so lange wie m\u00f6glich, da er den besten Schutz f\u00fcr das Nagelbett bietet. Einen m\u00f6glichen Nagelverlust kann man mit einem k\u00fcnstlichen Nagel abdecken.<\/li><li>Denke daran, dass <strong>Acryln\u00e4gel brennbar<\/strong> sind, wie eine interessante <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC8967465\/\">Studie<\/a> von 2022 zeigte.<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Wann sollte man ein subunguale H\u00e4matom drainieren? Und was ist die beste Methode &#8211; Nadel, hei\u00dfe B\u00fcroklammer, Kauter? Hier sind klare Infos, Schritt-f\u00fcr-Schritt-Vorgehen und wichtige praktische Tipps.  <\/p>\n","protected":false},"author":93452803,"featured_media":7201,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center 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