Comparison Of Winograde And Vandenbos Surgical Techniques According To Heifetz Stage In The Treatment Of Ingrown Toenails

Öz

Abstract Background: In ingrown toenail, classifications and the treatment approaches according to staging has been clearly reported in the literature. However, there are not enough data about the selection of the appropriate surgical technique according to the stage. In this study, we compared two different surgical techniques in patients with Heifetz stage 2 and 3 in means of surgical results, recovery time, patient comfort and cosmetics. Methods: Between January 2019 and January 21, patients who applied with the complaint of ingrown toenails who were treated with two mentioned surgical techniques in two centers with at least 1 year follow-up were included. The patients were evaluated preoperatively in means of the Heifetz classification. In group 1 (n:54) matrix excising Winograd and in group 2 (n:51) matrix preserving Vandenbos techniques were used. Postoperative recovery time, complication rates, functional and cosmetic patient satisfaction were evaluated in tall cases. Results: 105 cases of ingrown toenails treated surgically were included in the study. 62 (59%) cases were Heifetz stage 2, 43 (41%) cases were Heifetz stage 3. No statistically significant difference was found between Heifetz stage 2 and stage 3, regardless of surgical technique, in complication, recurrence, patient functional/cosmetic satisfaction rates, and recovery time. In overall analysis regardless of Heifetz staging, recovery time was shorter with Winograd method (p:0.0001), complication and recurrence rates were lower with Vandenbos method (p:0.0001), and VAS cosmetic satisfaction was higher in Vandenbos (p:0.002). Conclusion: Winograd and Vandenbos in Heifitz stages 2 and 3 have low complication rates and high patient satisfaction. Earlier healing could be achieved with the Winograd technique, while low complication/recurrence rates and high cosmetic satisfaction could be achieved with the Vandenbos technique. Early recovery/high cosmetic expectation should be considered instead of Heifetz staging in determining the surgical technique.

Anahtar Kelimeler

• ingrown toenail
• heifetz
• vandenbos
• winograd

Batık Tırnak Tedavisinde Winograde Ve Vandenbos Cerrahi Tekniklerinin Heifetz Evresine Göre Karşılaştırılması

Öz

Öz Amaç: Tırnak batmasında evrelemeye göre sınıflandırmalar ve tedavi yaklaşımları literatürde net olarak bildirilmiştir. Ancak evreye göre uygun cerrahi tekniğin seçimi konusunda yeterli veri bulunmamaktadır. Bu çalışmada Heifetz evre 2 ve 3 olan hastalarda iki farklı cerrahi tekniği cerrahi sonuçlar, iyileşme süresi, hasta konforu ve kozmetik açısından karşılaştırdık. Gereç ve Yöntem: Ocak 2019-21 Ocak tarihleri arasında tırnak batması şikayeti ile başvuran ve iki merkezde en az 1 yıl takipli olarak bahsedilen iki cerrahi teknikle tedavi edilen hastalar dahil edildi. Hastalar ameliyat öncesi Heifetz sınıflamasına göre değerlendirildi. Grup 1'de (n:54) Winograd matriks eksizyonu, grup 2'de (n:51) matriks koruyucu Vandenbos teknikleri kullanıldı. Bu olgularda ameliyat sonrası iyileşme süresi, komplikasyon oranları, fonksiyonel ve kozmetik hasta memnuniyeti değerlendirildi. Bulgular: Çalışmaya cerrahi olarak tedavi edilen 105 tırnak batması olgusu dahil edildi. 62 (%59) olgu Heifetz evre 2, 43 (%41) olgu Heifetz evre 3 idi. Heifetz evre 2 ile evre 3 arasında cerrahi teknik, komplikasyon, nüks, hasta fonksiyonel/kozmetik açısından istatistiksel olarak anlamlı fark bulunmadı. Memnuniyet oranları ve iyileşme süresi genel analizde Heifetz evrelemesinden bağımsız olarak Winograd yöntemi ile iyileşme süresi daha kısaydı (p:0.0001), Vandenbos yöntemi ile komplikasyon ve nüks oranları daha düşüktü (p:0.0001), Vandenbos'ta VAS kozmetik memnuniyeti daha yüksekti (p:0.002). Sonuç: Heifitz evre 2 ve 3'teki Winograd ve Vandenbos düşük komplikasyon oranlarına ve yüksek hasta memnuniyetine sahiptir. Winograd tekniği ile daha erken iyileşme sağlanırken, Vandenbos tekniği ile düşük komplikasyon/nüks oranları ve yüksek kozmetik memnuniyet sağlanabilmektedir. Cerrahi tekniğin belirlenmesinde Heifetz evrelemesi yerine erken iyileşme/yüksek kozmetik beklenti göz önünde bulundurulmalıdır.

Anahtar Kelimeler

• Tırnak batması
• heifetz
• vandenbos
• winograde

Kaynakça

1. 1. Heifitz CJ: Ingrown toenail: a clinical study. Am J Surg 38: 298, 1937.
2. 2. Richardson EG, Hendrix CL. The foot and ankle: disorders of nails and skin. In: Campbell’s Operative Orthopedics, ed 11, pp. 4762–4763, edited by ST Canale, JH Beaty, FM Azar, Mosby-Elsevier, Philadelphia, 2008
3. 3. Winograd AM. A modification in the technic of operation for ingrown toe-nail. 1929. J Am Podiatr Med Assoc. 2007 Jul-Aug;97(4):274-7. doi: 10.7547/0970274. PMID: 17660367.
4. 4. Vandenbos KQ, Bowers WF. Ingrown toenail: a result of weight bearing on soft tissue. U S Armed Forces Med J 1959;10:1168-73.
5. 5. Chapeskie H. Ingrown toenail or overgrown toe skin?: Alternative treatment for onychocryptosis. Can Fam Physician. 2008 Nov;54(11):1561-2. PMID: 19005128; PMCID: PMC2592332.
6. 6. Martínez-Nova A, Sánchez-Rodríguez R, Alonso-Peña D. A new onychocryptosis classification and treatment plan. J Am Podiatr Med Assoc. 2007 Sep-Oct;97(5):389-93. doi: 10.7547/0970389. PMID: 17901344.
7. 7. Kose O, Guler F, Gurcan S, Arik HO, Baz AB, Akalin S. Cosmetic results of wedge resection of nail matrix (Winograd technique) in the treatment of ingrown toenail. Foot Ankle Spec. 2012 Aug;5(4):241-4. doi: 10.1177/1938640012444729. Epub 2012 Apr 30. PMID: 22547536.
8. 8. Pettine KA, Cofield RH, Johnson KA, Bussey RM. Ingrown toenail: results of surgical treatment. Foot Ankle. 1988 Dec;9(3):130-4. doi: 10.1177/107110078800900307. PMID: 3229700.

9. 9. Acar E. Winograd Method Versus Winograd Method With Electrocoagulation in the Treatment of Ingrown Toenails. J Foot Ankle Surg. 2017 May-Jun;56(3):474-477. doi: 10.1053/j.jfas.2017.01.010. Epub 2017 Feb 24. PMID: 28242214.
10. 10. Karacan E, Ertilav D. Comparison of Vandenbos procedure or Winograd method for ingrown toenail. Jt Dis Relat Surg. 2021;32(2):414-419. doi: 10.52312/jdrs.2021.36. Epub 2021 Jun 11. PMID: 34145819; PMCID: PMC8343846.
11. 11. Nasr Y, Nasr A, Bettolli M. The effectiveness of nail excision versus Vandenbos procedure for the surgical management of ingrown toenails in children: A retrospective chart review. J Pediatr Surg. 2021 Oct;56(10):1857-1860. doi: 10.1016/j.jpedsurg.2021.03.001. Epub 2021 Mar 11. PMID: 33838895.
12. 12. Perry EP, O’Malley S, Mcgowan J, et al: A comparison of four nail-conserving procedures for ingrowing toenail. Br J Surg 71:912,1984.
13. 13. DeBrule MB. Operative treatment of ingrown toenail by nail fold resection without matricectomy. J Am Podiatr Med Assoc. 2015 Jul;105(4):295-301. doi: 10.7547/13-121.1. PMID: 26218152.
14. 14. Chapeskie H, Kovac JR. Case Series: Soft-tissue nail-fold excision: a definitive treatment for ingrown toenails. Can J Surg. 2010 Aug;53(4):282-6. PMID: 20646404; PMCID: PMC2912022.
15. 15. Peyvandi H, Robati RM, Yegane RA, Hajinasrollah E, Toossi P, Peyvandi AA, Ourang ZB, Shams A. Comparison of two surgical methods (Winograd and sleeve method) in the treatment of ingrown toenail. Dermatol Surg. 2011 Mar;37(3):331-5. doi: 10.1111/j.1524-4725.2011.01880.x. Epub 2011 Feb 16. PMID: 21324043.
16. 16. Antrum RM. Radical excision of the nailfold for ingrowing toenail. J Bone Joint Surg Br. 1984 Jan;66(1):63-5. doi: 10.1302/0301-620X.66B1.6693479. PMID: 6693479.
17. 17. Harıcharan R, Masqulıo J, Bettollı M: Nil-fold excision fort he teratment o ingrown toenail in children. J Pediatr 162: 398,2013.
18. 18. Kim J, Lee S, Lee JS, Won SH, Chun DI, Yi Y, Cho J. A Minimally-Invasive, Simple, Rapid, and Effective Surgical Technique for the Treatment of Ingrown Toenails: A Reminder of the Original Winograd Procedure. Int J Environ Res Public Health. 2021 Jan 1;18(1):278. doi: 10.3390/ijerph18010278. PMID: 33401516; PMCID: PMC7794890.