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V.P. Needle and curretage technique

Discussion in 'General Issues and Discussion Forum' started by David Smith, Dec 8, 2012.

  1. David Smith

    David Smith Well-Known Member

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    Hi all

    I don't know if anyone else is trying this, I've not sen it written about but lately I have been doing V.P. needling under LA and then remove the v.p. body with what I call a scraping curettage i.e. with the blade approaching 90dgs to the skin, scrape up the edge of the v.p. capsule and then continue like that all the way across gathering all the v.p. body as you go. This is done after needling about 300 times for a v.p. that is 8mm in diameter i.e lots of punctures. I have found that the needling seems to allow the v.p. to come away from the healthy tissue and a clean almost non haem lesion is left with no sign of v.p. tissue.
    I hav not had a return yet to see how sucessful in terms of the clear up rate it is but it looks very pleasing when done.

    Regards Dave
  2. blinda

    blinda MVP

    Yep, I do this with a curette (tricky to obtain in the UK. Got my miniature melon-baller in Spain) for HPV1 types in particular. They are generally 'screaming' to pop out after needling and the immediate pain relief it affords is very much appreciated by the pt.

    Isaacs does it the same way as you, I think. Or similar anyway.

  3. Admin2

    Admin2 Administrator Staff Member

  4. Yep.

    I'm increasingly of the view that identifying the type of hpv virus is critical to selecting the correct proceedure.
  5. David Smith

    David Smith Well-Known Member


    Good to hear your doing this, how are the results compared to just needling? I knew Robert did a blunt curettage on v.p. but I didn't know he combined it with needling.

    Regards Dave
  6. blinda

    blinda MVP

    From purely clinical observation, I would say recurrence is less likely with this combination technique in comparison with either curettage or needling alone.

    I used to just needle the single HPV1 types, but they are usually larger and form a thicker capsule which appears to increase resistance to tissue destruction. However, resolution rates have certainly increased since I started needling prior to removal of the tumour.

    The hypothesis is; tissue damage or ablation alone may not be enough to produce the relevant cytokines to destroy latent virus in adjacent cells, thus recurrence and further treatment is often required. It would appear that introducing already HPV infected keratinocytes into the subcutaneous layer, via the needling technique, facilitates an enhanced immune response in some patients to produce resolution.

    Robert and I have been discussing HPV sub-types for some time now and we agreed that the HPV sub-type should be identified when considering method of treatment (HPV1 are larger keratotic lesions, usually single. HPV2 are the superficial mosaic type and HPV4 are multiple, small keratotic lesions).

  7. David Smith

    David Smith Well-Known Member

    Is this discussed on another thread? if so can you say which one.

  8. blinda

    blinda MVP

    No, we just discussed it in KFC :eek:
  9. David Smith

    David Smith Well-Known Member

    AAh! Kent Foot College et comment?
  10. blinda

    blinda MVP

    Yes, that`s the one. They do a great Hot `n Spicy meal deal.

    The suggested enhanced cell-mediated response in association with needling is discussed in a paper which should be available soon......

    PS. A minor thing; Can you remove `Dry` from the tags, please? After all, it isn`t Dry Needling as we don`t use a solid needle nor are we performing intramuscular stimulation.


  11. With copious annotations and diagrams on napkins.
  12. Seamus McNally

    Seamus McNally Active Member

    PS. A minor thing; Can you remove `Dry` from the tags, please? After all, it isn`t Dry Needling as we don`t use a solid needle nor are we performing intramuscular stimulation.

    Hi Blinda,
    I don't think it matters calling it dry needling (i.e. without capitals) as that is what it is, whether the needle is solid or hollow. Anyways, small point and not why I replied. I am doing WMA thanks to Shane Tuohy's acupuncture for podiatrists, and he coming all the the way to Ireland. Funny enough I was only wondering today, given the theory behind VP dry (oops!) sorry needling and Western Medical Acupuncture if anybody has tried WMA for veruccae. Not into the actual VP but around it, in the belief that it might stimulate the body to fight the virus. This would not require an LA - I think!
    Anyone know of any research out there?
  13. Not sure a multiple puncture technique in the planter aspect of someone's foot without LA is something I'd fancy doing.
  14. Seamus McNally

    Seamus McNally Active Member

    Ah, I don't know, Robert, I've had a few in the sole simultaneously.But I'm not talking about anything like the 300 referenced in one reply. In this instance I'm talking about 2; at the most 3. and adjacent to the verucca not into it. On the basis that it might stimulate the body into action. Sure its all theory in my head, but thought someone might have tried it in the cause of research.
  15. It's an interesting thought. I guess a couple of needles stuck in the foot would cause a very mild inflammatory response, but I'd imagine that a lick of sal acid would do so far more, and for longer. Completely different mechanism to the falknor technique.

    In Portugal they sometimes simply inject LA directly under / into the lesion, using a prolotherapy principle. Different again.

    Out of interest, when you say "stimulate the body to fight the virus" what do you actually mean, in non Janet and John terms? What's the mechanism exactly?
  16. blinda

    blinda MVP

    Hi Séamus,

    Dry needling (with or without capitals ;)) is a term commonly used for intramuscular manual therapy, which often targets `trigger points`to address myofascial pain - an entirely different technique to verrucae needling, first described by Falknor. Personally, I think it only confuses pts and other health professionals if we use the same term for completely different procedures, don`t you?

    We are not using acupuncture needles and each puncture must produce pin-point bleeding, as we are `pushing` viral particles into the subcutaneous layer to encourage an enhanced cell-mediated immune response. This should be continued until there is no more resistance, or reactive pressure, from the epidermis and the entire lesion should be perforated enough to produce a beefy red wound....not really possible without LA.

  17. Ian Linane

    Ian Linane Well-Known Member

    Hi Bel
    I think you make a good point Bel. When doing intra-musculature techniques I encounter, only very occasionally, a pin point spot of blood. By contrast, using the VP needling technique there is deliberate injury with subsequent small bleed. In addition the dry needles are much finer and quite bendy.
  18. Ian Drakard

    Ian Drakard Active Member

    I have conducted a large scale trial on this (nb n=1. 'large being relative to the trials I haven't gotten round to doing yet ;) )

    I had a patient in and we discussed the normal needling procedure and booked them in for 3weeks later. While I was debriding vp to get better look and discussing needling I mentioned acupuncture and they asked to try it. Placed one needle in centre of lesion and one adjacent to it and 'stimulated' for 2 mins. Not pleasant but not too uncomfortable either.

    When they came in for the needling there wasn't anything to needle. So poorer podiatrist but happy patient :drinks

    May have been many other factors but might give it a try again if right person is in.
  19. blinda

    blinda MVP

    Indeed. I can relate similar incidents; pt wants the darn thing gone - will accept ANYTHING....don`t underestimate that placebo effect, particularly in relation to immune response. Silver nitrate `works`in the same way, IMVHO.

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