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Nail Surgery for patient with Von Willebrand's Disease?

Discussion in 'General Issues and Discussion Forum' started by viennapod, Nov 12, 2011.

  1. viennapod

    viennapod Member


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    Hi
    I have a 54 year old female, referred by her GP for surgical management of ingrowing toenails. Initially she was referred to the local hospital for surgery due to her bleeding disorder, Von Willebrand's disease. However, hospital cut backs have hit and she has been removed from their waiting list.
    i have not treated anyone with this disorder before and just looking for some advice regarding pre and post op care. I'm looking at doing a bilateral matrixectomy with NaOH/Acetic acid.
    Thanks
    Charlotte
     
  2. Admin2

    Admin2 Administrator Staff Member

    Von Willebrand disease

    Von Willebrand disease (VWD) is the most common hereditary blood-clotting disorder in humans. An acquired form can sometimes result from other medical conditions.[1] It arises from a deficiency in the quality or quantity of von Willebrand factor (VWF), a multimeric protein that is required for platelet adhesion. It is known to affect several breeds of dogs as well as humans. The three forms of VWD are hereditary, acquired, and pseudo or platelet type. The three types of hereditary VWD are VWD type 1, VWD type 2, and VWD type 3. Type 2 contains various subtypes.[2] Platelet type VWD is also an inherited condition.[3]

    In 2008 a new diagnostic category of "Low VWF" was proposed to include those individuals whose von Willebrand factor levels were below the normal reference range but not low enough to be von Willebrand disease (levels in the 30-50 IU/dL range).[4] Patients with low VWF can experience bleeding, despite mild reductions in VWF levels.[5]

    VWD type 1 is the most common type of the disorder, with mild bleeding symptoms such as nosebleeds, though occasionally more severe symptoms can occur. Blood type can affect the presentation and severity of symptoms of VWD.[6]

    VWD type 2 is the second most common type of the disorder and has mild to moderate symptoms.

    The factor is named after the Finnish physician Erik Adolf von Willebrand who first described the condition in 1926. Guidelines for the diagnosis and management of VWD were updated in 2021.[7][8]

    1. ^ "Von Willebrand disease: MedlinePlus Medical Encyclopedia". www.nlm.nih.gov. Retrieved 2016-06-26.
    2. ^ Goodeve A, James P (1993). "von Willebrand Disease". PMID 20301765. {{cite journal}}: Cite journal requires |journal= (help)
    3. ^ Swystun LL, James PD (January 2017). "Genetic diagnosis in hemophilia and von Willebrand disease". Blood Reviews. 31 (1): 47–56. doi:10.1016/j.blre.2016.08.003. PMID 27596108.
    4. ^ Nichols WL, Hultin MB, James AH, Manco-Johnson MJ, Montgomery RR, Ortel TL, Rick ME, Sadler JE, Weinstein M, Yawn BP (March 2008). "von Willebrand disease (VWD): evidence-based diagnosis and management guidelines, the National Heart, Lung, and Blood Institute (NHLBI) Expert Panel report (USA)". Haemophilia. 14 (2): 171–232. doi:10.1111/j.1365-2516.2007.01643.x. PMID 18315614.
    5. ^ Lavin M, Aguila S, Schneppenheim S, Dalton N, Jones KL, O'Sullivan JM, O'Connell NM, Ryan K, White B, Byrne M, Rafferty M, Doyle MM, Nolan M, Preston RJ, Budde U, James P, Di Paola J, O'Donnell JS (November 2017). "Novel insights into the clinical phenotype and pathophysiology underlying low VWF levels". Blood. 130 (21): 2344–2353. doi:10.1182/blood-2017-05-786699. PMC 5881608. PMID 28916584.
    6. ^ "Von Willebrand Disease". hemophilia.org. 4 March 2014. Retrieved 4 April 2018.
    7. ^ James PD, Connell NT, Ameer B, Di Paola J, Eikenboom J, Giraud N, et al. (2021-01-12). "ASH ISTH NHF WFH 2021 guidelines on the diagnosis of von Willebrand disease". Blood Advances. 5 (1): 280–300. doi:10.1182/bloodadvances.2020003265. ISSN 2473-9529. PMC 805340. PMID 33570651.
    8. ^ Connell NT, Flood VH, Brignardello-Petersen R, Abdul-Kadir R, Arapshian A, Couper S, et al. (2021-01-12). "ASH ISTH NHF WFH 2021 guidelines on the management of von Willebrand disease". Blood Advances. 5 (1): 301–325. doi:10.1182/bloodadvances.2020003264. ISSN 2473-9529. PMC 805326. PMID 33570647.
     
  3. Jose Antonio Teatino

    Jose Antonio Teatino Well-Known Member

    If the technique for incisional onychocryptosis is really not, you should have problemas.
    Personalmente Fenol use.
    Is common practice in patients treated with acenocoumarol.
    Regards:
    Jose A. Teatino
    Professor of Surgery
    The Academy of Ambulatory Foot & Ankle Surgery
     
  4. Jose Antonio Teatino

    Jose Antonio Teatino Well-Known Member

    I meant: there should be problemas.
    Lamento google my bad English
     
  5. barry hawes

    barry hawes Active Member

    Hi all,

    About 20 years ago I did a partial nail ablation on an 18 yo young lady. Procedure went fine but I couldn't stop the bleeding, even after 10 minutes of digital pressure. Finally stopped with alginate packing, further pressure, elevation and time. Wound healed uneventfully and there was no nail regrowth.

    The young lady came to see me with another foot condition 5 years later. By then she had delivered her first child and, in the process, had been diagnosed with Von Willebrand's disease.

    For what it's worth, now that you are forwarned, perhaps dressing materials which enhance clotting may enable you to safely provide PNA on your patient. As an aside, I have used alginate dressings when performing PNAs on patients low doses of warfarin as well.

    Would be interested to hear of your reasons for chosing NaOH over phenol, and details of how you apply and neutralise it.

    Kind regards,

    Barry Hawes
     
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