How low should you go: Novel device for nail trephination

BACKGROUND The most commonly used treatment for subungual hematomas is nail trephination, a technique that is not standardized and that poorly controls for trephination depth. OBJECTIVE The objective was to test the safety and tolerance of a new device for nail trephination that uses innovative "mesoscission" or microcutting technology to create holes of specific depths in the nail plate without penetrating the nail bed. MATERIALS AND METHODS Fourteen adult subjects with healthy toenails had five holes drilled in a random single-blind fashion at different test settings into their right great toenail with this device and were assessed for pain and pressure tolerance as well as perioperative and postoperative complications. RESULTS Nail trephination with this device in this small pilot study was controlled and well tolerated. LIMITATIONS The study population was small (n=14) and the follow-up evaluation relied on patient self-report, which is not always reliable. The follow-up period was only 1 week and did not allow for evaluation of permanent nail plate deformity. CONCLUSION Mesoscission may be a controlled and practical alternative to traditional nail trephining methods. Path Scientific, LLC (Carlisle, MA) provided the equipment and 100% of the funding for this study. Dr. Ciocon and Dr. Kimball are affiliated with the Department of Dermatology, Brigham and Women's Hospital (Boston, MA). Neither has any financial relationship with Path Scientific. Dr. Gowrishankar is an employee of Path Scientific but has no financial interests in the company. Terry Herndon is President of Path Scientific, LLC, and provides 100% of funding for its costs. He is the owner and inventor of the PathFormer device.