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Ingrown Toenails

Heidi James, MD
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Do we have it all wrong with ingrown toenails? Some feel that we should be describing it as overgrown skin rather than an issue with the nail itself. This may seem like a quibble of semantics, but it has major implications on management. The Vandenbos procedure is a removal of periungual skin with impressive results in resolving ingrown toenails.


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Casey P. -

Great stuff Heidi

I am a survivor of 10+ Paediatric toenail resections / wedge excisions and hundreds of infections!
And then as a Pads Surgery Resident I learned this procedure from an old surgeon - we would do one side each under a GA - and it is how I learned to sew pretty much!
However, it seems to be a procedure that is seldom performed in practice.

I'll send you a pic of my ugly gt toe for your collection - wish I had that operation when I was a kid! Excess toe skin is definitely the problem!

Heidi J., MD -

If your toe (yes! pls send a pic) ever becomes an issue again, Casey, I will be happy to fly down there and fix it up! Game changer of a procedure for me. And it's catching on around here, which is nice to see.

Kevin W. -

I cannot believe this procedure was brought up on the pod. I randomly stumbled across the website that HJ mentioned last month and began asking around with my colleagues. Blank stares and confused questions. With the above endorsements, it is time to start a trend here in the Midwest.

Vanessa C. -

Anyone have experience doing it on people who have diabetes and generally poor circulation? A lot of my patients have diabetes and members of the First Nations population where I work tend to get terrible skin infections very easily (multifactorial causes but kids are often admitted with terrible eczema, a significant number of patients get post-op wound infections... ) Heard about the technique years ago but have been too scared to try it on my local patient population for fear of complications.

Heidi J., MD -

I've done it in some well-ish controlled diabetics. I see them more frequently in f/u; no problems thus far. I don't do Vandebos in the PVD/PAD gang.

Jose D., PA-C -

Thanks for sharing this! Bigtime practice changer for me! I'm looking foreword to giving this a go. Working in a very remote environment with captive populations that stay for 2-3 weeks at a time, will help with the follow up.

Heidi J., MD -

Super, Jose! It is a slick procedure. Keep us posted!

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