When is the Vandenbos procedure indicated?
The Vandenbos procedure is indicated for patients with classic onychocryptosis, most of whom are in their second or third decade of life. It is not recommended for patients with dystrophic nails, fungal infections, or thick, discoloured, curling nails, as seen in the elderly.
What is the difference between Winograd and Vandenbos procedures?
Low recurrence rates, high satisfaction, and good cosmetic results can be achieved with the Vandenbos procedure, while recovery time and return to work are faster with the Winograd method. The appropriate surgical technique should be selected based on the individual patient.
Can the Vandenbos procedure treat onychocryptosis?
INGROWN TOENAILS EGECOAILEICINE VOL NO | A 1 | THE ORNAL O AIL PRACTICE203 The Vandenbos procedure can definitively treat onychocryptosis with a good cosmetic outcome. Postoperative care After 48 hours, the patient can remove the dressing and gently rinse the wound and reapply a new dressing as before.
Is the Vandenbos procedure an effective treatment for hallux pain?
The Vandenbos procedure, described here, is an effective surgical option. CASE u A 22-year-old active-duty man presented with left hallux pain, which he had experienced for several years due to an “ingrown toenail.”
Is toenail debridement painful?
Let's now look at the definitions. Debridement of Toenails: Nail debridement involves the significant reduction in the thickness and length of the nail to the tolerance of the patient with the aim of allowing the patient to ambulate without pain.
How painful is toenail removal recovery?
Typical recoveries have limited to no discomfort and usually alleviate ingrown nail discomfort within 24 hours.
Is Matricectomy painful?
This in office procedure is painless once the toe is anesthetized. It takes less than a few minutes to complete the procedure. Once the toe is numbed up, the portion or portions of the nail that are causing the pain are removed using special sterilized instruments designed specifically for this procedure.
What is the procedure to remove ingrown toenail?
What is the recommended surgical procedure for ingrown nails? Surgical removal of an ingrown nail involves removing a small portion of the side of the nail and destroying the nail bed beneath. The toe is injected with a numbing medicine, and the toenail is cut to create a new, straight nail edge.
How long after toenail removal can I walk?
If that happens, a repeat procedure is usually done. Patients that are involved in walking, running, or athletic activity can typically return to activity within 2-3 days for removal of infected toenail and 5-7 days for a permanent nail procedure with chemical application.
How does a podiatrist remove a toenail?
Once you're prepped, the doctor will use scissors and special tools to separate your toenail from the bed, making a vertical cut from the ingrown side down to the cuticle. They'll then remove the cut section. If necessary, the entire nail may be removed, particularly if both sides of your nail are ingrown.
Will toenail grow back after Matrixectomy?
When performed with a chemical matrixectomy, the nail will not regrow and you will no longer suffer from the problems your toenail was causing. When performed without, the nail will regrow from scratch, a process that takes approximately 12 months.
How long is recovery Matrixectomy?
A retrospective study showed a healing time from 2 to 4 weeks [25], with similar results to a prospective research that reported the return to normal activity after partial chemical matricectomy in 3.89 weeks [26].
Can your toenail fall off after ingrown toenail surgery?
There are very few complications associated with this procedure. Reoccurrence of the ingrown toenail can occur a small percentage of the time. Continuation of the infection is possible which can be controlled easily with oral antibiotics. On occasion, the remaining nail may become loose from the nail bed and fall off.
Does ingrown nail surgery hurt?
The entire ingrown toenail surgery is completely painless due to the effects of the anesthetic. By the time the anesthetic wears off, your pain level will be significantly reduced from where it was before the procedure. Downtime is extremely minimal for almost all patients.
Are you awake during ingrown toenail surgery?
Ingrown toenail surgery is usually an outpatient procedure that involves the use of local anesthesia. Local anesthesia means that the person remains awake, but the doctor numbs the area so that the person cannot feel their toe. Some doctors offer a sedative or twilight anesthesia during the surgery.
How successful is ingrown toenail surgery?
Nail avulsion surgery has a 98.5 per cent success rate, but in the rare case that the surgery is unsuccessful, we will organise to re-do the procedure at no extra cost to you. Depending on your medical history and whether there is an infection due to the ingrown toenail, healing can vary from person to person.
How to perform Vandenbos procedure?
For the Vandenbos procedure, the toe was cleaned with iodine solution, and a digital nerve block without epinephrine was performed with 2% prilocaine. An elastic tourniquet was placed proximal to the toe to provide a bloodless operating field and administration of local anesthetic into the tissue. An incision, measuring 5 mm in size, was made proximally while leaving the nail bed intact. Beginning approximately 3 mm from the lateral edge of the base of the nail, the nail matrix was protected. An elliptical sweep was made out to the side and bottom of the toe, extending distally to encompass all involved granulation tissue and nail-fold skin. The incision continued approximately 3 to 5 mm from the edge below the nail tip. The skin and subcutaneous tissues at the edge of the nail were removed. The excision should be large and sufficient. If enough tissue was removed, skin and soft-tissue defect, measuring 1.5X3 cm, was able to be formed. The tourniquet was opened and pressure was applied for 3 min, bleeding foci were cauterized to reduce postoperative bleeding. At this stage, a special care was paid not to damage the nail matrix. The wound should be left to secondary tissue healing. There would be bleeding due to postoperative leakage, a large amount of non-stick gauze should be applied to the wound area with pressure.
What is the infection rate after Winograd?
In a study conducted by Huang et al.,[15] an infection rate of 3.2% was reported as a complication after the Winograd method for an ingrown toenail. In the current study, postoperative bleeding was observed in two patients in the Vandenbos procedure group, while the infection was observed in six patients, spicule formation was noted in three patients, and excessive granulation tissue was detected in two patients in the Winograd group. The comparison of the two groups showed that a higher number and variety of postoperative complications occurred in the Winograd group.
How many patients were satisfied with Winograd?
While 56 (80%) of the 70 patients who underwent Winograd surgery satisfied with the surgery, 74 (98%) of the 75 patients who underwent Vandenbos procedure were satisfied with the surgery (p<0.001). When the patients were evaluated in terms of cosmetics, 60 (85%) of the patients in Group 1 and 74 (98%) of the patients in Group 2 were satisfied (p=0.003). The pre- and postoperative images of the Vandenbos procedure and Winograd method are shown in Figures 1 and 2.
Does Winograd procedure recur?
Although the Winograd method is widely used for ingrown toenail surgery, its recurrence rates vary in studies. For instance, a study reported the recurrence rate as 16% following wedge resection and partial matricectomy.[10] Moreover, two different comparative studies reported the recurrence rates as 21% and 7%, respectively.[7,11] In a study comparing the Winograd method and sleeve technique, the recurrence rate of the Winograd method was 12%.[8] Likewise, in our study, 10 (14%) Winograd group patients had a recurrence. Vandenbos[3] reported the recurrence rate as 0% in his original article. Likewise, in the case series conducted using the Vandenbos procedure, the authors did not report recurrence in any patient.[4] In the study, Noël[12] recently described a procedure similar to the Vandenbos procedure, but performed different approximation sutures. In this study, 23 patients were under follow-up for one year, and no recurrence was observed in any of the patients. In the present study, we did not observe recurrence in any of our patients in the Vandenbos group.
Does Vandenbos procedure have a recurrence rate?
The most important finding of this study was that Vandenbos procedure has low recurrence and a higher cosmetic satisfaction rate.[9] Although ingrown toenail is a condition that can occur at any age, it commonly affects younger individuals and restricts the daily physical activities of the patient, and therefore, it must be treated. Currently, no ideal surgical technique has been defined for the treatment of ingrown toenails. The characteristics of an ideal treatment for ingrown toenail are that postoperative comfort should be good, it should provide a quick return to normal activities, and should be simple and inexpensive.[8] Moreover, acceptable cosmetic results, as well as low complication and recurrence rates, are of importance.[7]
Is Vandenbos surgery faster than Winograd?
Low recurrence rates, high satisfaction, and good cosmetic results can be achieved with the Vandenbos procedure, while recovery time and return to work are faster with the Winograd method. The appropriate surgical technique should be selected based on the individual patient.
Is there a difference between VAS scores after one week?
When the VAS pain scores were compared between the two groups, the postoperative first-week VAS scores were found to be higher in the patients who underwent the Vandenbos procedure, compared to those who were treated with the Winograd method. No clinical difference was observed between the VAS scores after one week. Although there is no study on postoperative pain scores for ingrown toenails in the literature, we attributed the higher one-week VAS scores after the Vandenbos procedure to more aggressive tissue excision.
How does Vandenbos procedure work?
Since 1988 Dr. Henry Chapeskie has performed this procedure on over 2,700 patients who had no recurrences. Unlike other procedures, the Vandenbos procedure does not touch the nail. In this procedure, the affected toe is anesthetized with a digital block and a tourniquet is applied. An incision is made proximally from the base of the nail about 5 mm (leaving the nail bed intact) then extended toward the side of the toe/toenail in an elliptical sweep to end up under the tip of the nail about 3–4 mm in from the edge. It is important that all the skin at the edge of the nail be removed. The excision must be adequate leaving a soft tissue deficiency measuring 1.5 × 3 cm. A portion of the lateral aspect of the distal phalanx is occasionally exposed without fear of infection. Antibiotics are not necessary as the wound is left open to close by secondary intention. Postoperative management involves soaking of the toe in warm water 3 times/day for 15–20 minutes. The wound is healed in 4–6 weeks. No cases of osteomyelitis have been reported. After healing, the nail fold skin remains low and tight at the side of the nail. The rationale is that the nail itself is usually healthy, but overgrown by skin; when walking, the bilateral nail folds are pressed upwards, which is why narrowing the nail causes excessive recurrences, contrary to narrowing the nail fold.
What is wedge resection?
Some use "lateral onychoplasty," or "wedge resection," as the method of choice for ingrown toenails. A wide wedge resection, with a total cleaning (removal) of nail matrix, has a nearly 100% success rate. Some physicians will not perform a complete nail avulsion (removal) except under extreme circumstances. In most cases, these physicians will ...
Is avulsion a recurrence?
Avulsion procedure. In case of recurrence after complete removal, and if the patient never felt any pain before inflammation occurred, the condition is more likely to be onychia which is often confused for an ingrown or ingrowing nail ( onychocryptosis ). Complete removal of the whole nail is a simple procedure.
How long does it take to get a Vandenbos toe removed?
The "overgrown toeskin" around your toenail is removed by your doctor. Your nail is not cut or removed - there is nothing wrong with your nail! The whole procedure takes about 20 minutes for 1 toe and 30 minutes for 2 toes.
Can you feel anything during Chapeskie surgery?
It can also easily be done in the family doctor's office. Your toe will be frozen and you will not feel anything during the surgery.
Is Vandenbos a minor surgery?
The Vandenbos Procedure offers patients a minor surgery that is only needed once (it will cure your problem!). It also leaves your nail untouched and your toe will look great! This surgery can easily be done in a family doctor's office. . The Vandenbos Procedure is a minor surgery.
What is Vandenbos procedure?
The Vandenbos procedure is a rational physiologic approach to the problem of overgrown toe skin (onychocrypt osis) and yields a curative, cosmetically excellent result. Not surprisingly, patient satisfaction reflects this.
Can Vandenbos be used for onychocryptosis?
The Vandenbos procedure is indicated for patients with classic onychocryptosis, most of whom are in their second or third decade of life. It is not recommended for patients with dystrophic nails, fungal infections, or thick, discoloured, curling nails, as seen in the elderly.
Robertisaacs MVP
This from the website of a Dr Henry Chapeskie, Who obviously also wrote the wiki page entry for the proceedure... (is he your hucklebury Graham?)
Graham RIP
Dr Henry Chapeskie was I believe who taught the MD up North! I can't believe such an invasive procedure for something as simple as an ingrown nail can be justified.
Robertisaacs MVP
Maybe he's just not afraid of the infection and just you and I are 'soft' Robert?
Overview
Vandenbos procedure
The Vandenbos procedure was first described by Vandenbos and Bowers in 1959 in the US Armed Forces Medical Journal. They reported on 55 patients, all without recurrences. Since 1988 Dr. Henry Chapeskie has performed this procedure on over 2,700 patients who had no recurrences. Unlike other procedures, the Vandenbos procedure does not touch the nail. In this procedure, the affected toe is anesthetized with a digital block and a tourniquet is applied. An incision is made …
Wedge resection
The physician will perform an onychectomy in which the nail along the edge that is growing into the skin is cut away (ablated) and the offending piece of nail is pulled out. Any infection is surgically drained. This process is referred to as a "wedge resection" or simple surgical ablation and is not permanent (i.e., the nail will re-grow from the matrix). The entire procedure may be performed in a physician's office in approximately thirty to forty-five minutes depending on the e…
Avulsion procedure
In case of recurrence after complete removal, and if the patient never felt any pain before inflammation occurred, the condition is more likely to be onychia which is often confused for an ingrown or ingrowing nail (onychocryptosis). Complete removal of the whole nail is a simple procedure. Anaesthetic is injected and the nail is removed quickly by pulling it outward from the toe. The patient can function normally right after the procedure and most of the discomfort goe…
The Syme procedure
In difficult or recurrent cases of onychocryptosis (ingrown toenail) the patient's symptoms persist necessitating a permanent operative solution. The "avulsion procedure" is simple but the surgeon must be skilled enough to accomplish total destruction, and removal of, the nail matrix. Another disadvantage is the long healing and recovery time(> 2 months). In these cases, the best method is the Syme procedure, that means total nail matrix removal + skin flap transfer + phalanx partia…
Phenolisation
Following injection of a local anaesthetic at the base of the toenail and perhaps application of a tourniquet, the surgeon will remove (ablate) the edge of the nail growing into the flesh and destroy the matrix area with phenol to permanently and selectively ablate the matrix that is producing the ingrown portion of the nail (i.e., the nail margin). This is known as a partial matrixectomy, phenolisation, phenol avulsion or partial nail avulsion with matrix phenolisation. Also, any infectio…
External links
• "Ingrown Toenails" Information regarding ingrown toenails and a detailed description of the Vandenbos procedure including pictures, research articles and a video of the procedure
• "Nail Surgery" Chapter 33 of Textbook of Hallux Valgus and Forefoot Surgery,complete text online in PDF file