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Vandenbos procedure for ingrown toe nails! Yikes!

Discussion in 'Foot Surgery' started by Graham, Nov 1, 2010.

  1. Graham

    Graham RIP

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    I was up in Northern Ontario recently educating some Nurses and PSWs who work on the Reserves. Over the past few months a young and enthusiastic MD has been practicing his new found surgical prowess with the Vandenbos procedure for ingrown toe nails.

    It seems practicing on patients with diabetes without checking there INR or vacsular status can be problematic. 2 patients required amputations, four were salvaged but only just and not very pretty! ( I have some pics but have to make them smaller)
  2. bob

    bob Active Member

    There's been a thread on here about this before. Here's a link to a video of the procedure on a guy from Canada's website:

    http://www.ingrowntoenails.ca/procedure video.htm

    I can't say it's something I'll be offering anytime soon since I have good results from the standard nail surgery techniques. How ironic that your MD's medical management of his patients is lacking?!!
  3. 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?)


    Sweet mother of mercy!!!

    How in the name of heaven do you expose bone and not fear infection!?!?!?!

    Apparently there is a negligable regrowth rate. I suspect, graham, that your amputees would not be comforted to know they are part of that statistic!!!
    Last edited by a moderator: Dec 26, 2017
  4. bob

    bob Active Member

    Maybe he's just not afraid of the infection and just you and I are 'soft' Robert? I do agree though, I haven't had a single regrowth following an amputation.... yet :santa2:
  5. 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.:confused:
  6. bob

    bob Active Member

    I guess it's another way of looking at the problem that I'd not really considered (given really good results with nail surgery). I suppose it's like taking a negative cast of the foot and forming your orthotic shell to the negative - what sort of crazy person would do that? It's a topsy turvy mad world we live in these days! ;)
  7. Yeah, real men don't fear osteomylitis.:D We're cissies.
    :rolleyes: Bit like that... Apart from the blood. And the infection risk. And the amputations. But otherwise Identical ;).
  8. bob

    bob Active Member

    Yes, apart from all that it's identical. Let's not forget that the Vandenbos procedure has some potential drawbacks, but lets also not forget that you can get some pretty nasty blisters on the heel if you don't adequately allow for lateral expansion in your heel cup. :D

    Tea is for mugs. :morning:

    Attached Files:

  9. Blisters you say?!

    Disgusting. Shouldn't be allowed...

    Although Vern Houston et al (2006) found the maximal heel width expansion on weight bearing to average about 3.5mm of lateral expansion... and the bandage was 2 or 3 mm thick each side... so there is essentially 4-6 mm of lateral expansion intrinsic to the technique (whether you want it or not)... :rolleyes:

    How anal and pedantic am I?;)

    More of a worry for me with that one is you always get a round heel cup. Rather hard to wedge or skive. But we digress.

    Vandenbos. No regrowths, few amputations.
  10. Graham

    Graham RIP

    HeY! Maybe we could surgically resect the medial and lateral fat pad of the heel. We could charge more and wouldn't have to worry about plaster expansions on our orthoses.

    What should we call this procedure?
  11. bob

    bob Active Member

    How about the 'Randomtos procedure'? Last to publish on it is a big girl! :D
  12. G Flanagan

    G Flanagan Active Member

    That is the most ridiculous first line procedure for a nail i have ever seen

    ps did you see the hefty nail spike he left on the fibular border?
  13. Would it regrow?
  14. bob

    bob Active Member

    That is a possibility with the 'Randomtos procedure' indeed - especially in patients who eat a large volume of 'cake'. All patients undergoing the procedure should be made aware of this prior to surgery. Of course, if there is regeneration of the heel pad, we can perform surgery to the orthotic itself. This suits busy patients who can leave their orthotic with the clinic for its surgery. We can perform surgical debridement of the internal surface of the heel cup of the orthotic as a day case procedure. It's a painless procedure and is usually performed on a day-case basis. I rarely need to use local anaesthetic at all in any of the 'orthotic surgery' I perform.
    Last edited by a moderator: Sep 22, 2016
  16. There have been times. Generally when I perform an inadvertant PNA with a belt grinder.
  17. Graham

    Graham RIP

    See PDF attached

    Attached Files:

  18. bob

    bob Active Member

    Simon - was that directed at my earlier comment? If so, be assured that most of my posts in this thread are written with my tongue firmly in my cheek. I can not see the need to re-invent (or in this case invert) the wheel.
  19. Nope it was directed at the pdf Graham linked to.
  20. bob

    bob Active Member

    Fair enough. However, since I've never been a fan of Black Sabbath (mainly because of Ozzy Osbourne's extreme lack of talent), here is a marginally better version of 'paranoid' for you:
    I find the major improvement in the 2 versions is the actions of the vocalist during the solo. Very considerate - perhaps he used to have a clinic doing cut and come agains?:D
  21. Mr C.W.Kerans

    Mr C.W.Kerans Active Member

    The use of the Vandenbos Procedure is as good example as you are likely to find of the principle that because you can do something doesn't mean to say that you should do it. It amounts to unnecessary butchery.
  22. Ian Drakard

    Ian Drakard Active Member

    Oh golly I'd forgotten about this thread! Are you suggesting we put lots of 'likes' up to try and create a resurgence of this procedure so we can benefit from clearing up all the mess that will be left?

    Seen a few Zadiks (spelling?) or similar in young healthy people that have been less great cosmetically but nothing on this!
    Last edited: Dec 12, 2011
  23. At least with a zadiks, the skin flaps are sutured back together to heal be tertiary intention. As opposed to leaving a big ass hole to heal by secondary!

    Nice idea, but I understand If the proceedure goes badly we're in amputation territory. Not much left to fix...
  24. frintonpod

    frintonpod Member

    I'm aware this thread is a long time dead but I showed a client this video today as she wanted something to startle her son-in-law with.

    I also showed her Dr Parekh Ankle Block video. Needless to say she squealed when she saw the LA shooting across the clinic floor from out the other side of his ankle.
  25. Paul Bowles

    Paul Bowles Well-Known Member

    Where do they get the skin grafts from? I crack myself up sometimes!!!!
  26. davidh

    davidh Podiatry Arena Veteran

    I must have missed this one first time around.

    What the ???????
  27. This thread always makes me miss graham...

    Yep. Tis one of the video on my "for freaking out students" playlist.
  28. JamesC

    JamesC Member

    Umm... Yikes is all that springs to mind! Slight overkill for a PNA i would have thought? A simple removal & phenol ablation seems to do the trick for us.... 5% regrowth rate on the hundreds of procedures we do and no lack of sides of the toe!!! Blimey, i feel sorry for the patients going under the knife for the Vandenbos procedure!!! We always ask patients if they've searched youtube for "Ingrowing Toenail Surgery" to find out what they're in for, and generally the more nervous of the patients all say "Yes!! You're not going to cut off the sides of my toes are you???" while sometimes very loudly gibbering into a magazine we've swiftly shoved under their noses!
  29. Just when you thought it was safe...

    Has anyone ever wondered what the vandenbos proceedure looks like AFTER the surgery...


    Dear sweet mother of mercy, why would anyone do this to themselves!?!?!
  30. This comment on the last video says it all...

  31. frintonpod

    frintonpod Member

    Really! REALLY!!

    He even says that this would make an excellent torture method. Does anybody else see the irony of him having this procedure to resolve his IGTN, then during the debridement, they both fall off!
  32. I'm not sure what's in video one counts as debridement so much as, well, picking at it I guess you'd say.

    The other two are, if anything, worse.
  33. Mr C.W.Kerans

    Mr C.W.Kerans Active Member

    I wonder is there not an issue of malpractice with this procedure?
  34. This proceedure in general? I doubt it. As horrendously aggressive as it is, I imagine there is a success rate, and the choice of surgical procedure is a delicate one.

    This proceedure in particular? I certainly would not want to defend it. He uploaded the actual operation here


    And his cross infection precautions are really very shoddy indeed. If one were to do a root cause analysis on the subsequent infection and necrosis there are lots of things to raise. Not hard to see how it happened.

    Or did you mean the debridement. Leaving the surgery aside, the debridement of the necrotic tissue is far from the best example I've ever seen. Again, there is a fairly flagrant disregard for aseptic technique.
  35. Paul Bowles

    Paul Bowles Well-Known Member

    Sorta makes the PNA's we do and have them 100% healed in 10-14 days with minimal pain under LA seem almost boring! All of the top Podiatrists in my area I find it difficult to tell what toe they even operated on they look so good!
  36. NewsBot

    NewsBot The Admin that posts the news.

    Comparison of Vandenbos procedure or Winograd method for ingrown toenail
    Erkan Karacan, Devran Ertilav
    Jt Dis Relat Surg. 2021;32(2):414-419

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