Nonrandomized assessment of ingrown toenails treated with excision of skinfold rather than toenail (NAILTEST): An observational study of the Vandenbos procedure

Published:February 10, 2017DOI:



      The Vandenbos procedure for ingrown toenails consists of excising the surrounding skinfold and allowing the wound to heal by secondary intention. Previous studies have documented low rates of recurrence, but patient-reported outcomes remain uncertain.


      This study was a prospective, observational assessment of children and adolescents who underwent the Vandenbos procedure for one or more ingrown toenails. Standardized assessments of pain, functional status, and quality of life were completed before surgery and then one, two, and six months postoperatively.


      Thirty-nine participants (with 59 ingrown toenails) completed at least one postoperative assessment and were included in the analysis. Age ranged from 4 to 20 years (mean 13.5 years). Recovery time was a median of 7 days for return to school or work and 23 days for being able to wear enclosed shoes. Seven participants (18%) experienced one or more minor complications within the first two months of surgery. There were no recurrences. Ninety-five percent of participants and 100% of parents would recommend the Vandenbos procedure.


      We conclude that the Vandenbos procedure is associated with a low recurrence rate in children, adolescents, and young adults with ingrown toenails. Patient-reported recovery time, complication rate, functional outcomes, and satisfaction are excellent.

      Level of evidence


      Key words

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        • Yang G.
        • Yanchar N.L.
        • Lo A.Y.
        • et al.
        Treatment of ingrown toenails in the pediatric population.
        J Pediatr Surg. 2008; 43: 931-935
        • Mitchell S.
        • Jackson C.R.
        • Wilson-Storey D.
        Surgical treatment of ingrown toenails in children: what is best practice?.
        Ann R Coll Surg Engl. 2011; 93: 99-102
        • Heidelbaugh J.J.
        • Lee H.
        Management of the ingrown toenail.
        Am Fam Physician. 2009; 79: 303-308
        • Eekhof J.A.
        • Van Wijk B.
        • KnuistinghNevan A.
        • et al.
        Interventions for ingrowing toenails.
        Cochrane Database Syst Rev. 2012; : CD001541
        • Vandenbos K.Q.
        • Bowers W.F.
        Ingrown toenail: a result of weight bearing on soft tissue.
        U S Armed Forces Med J. 1959; 10: 1168-1173
        • Chapeskie H.
        • Kovac J.R.
        Case series: soft-tissue nail-fold excision: a definitive treatment for ingrown toenails.
        Can J Surg. 2010; 53: 282-286
        • Haricharan R.N.
        • Masquijo J.
        • Bettolli M.
        Nail-fold excision for the treatment of ingrown toenail in children.
        J Pediatr. 2013; 162: 398-402
        • Bose B.
        A technique for excision of nail fold for ingrowing toenail.
        Surg Gynecol Obstet. 1971; 132: 511-512
        • Brereton R.J.
        Simple old surgery for juvenile embedded toenails.
        Z Kinderchir Grenzgeb. 1980; 30: 258-264
        • Antrum R.M.
        Radical excision of the nailfold for ingrowing toenail.
        J Bone Joint Surg Br. 1984; 66: 63-65
        • Persichetti P.
        • Simone P.
        • Li Vecchi G.
        • et al.
        Wedge excision of the nail fold in the treatment of ingrown toenail.
        Ann Plast Surg. 2004; 52: 617-620
        • Nonrandomized Assessment of Ingrown ToenaiLs Treated by Excision of Skinfold Rather Than Toenail (NAILTEST)
        • Mozena J.D.
        The Mozena classification system and treatment algorithm for ingrown hallux nails.
        J Am Podiatr Med Assoc. 2002; 92: 131-135
        • Barton G.R.
        • Sach T.H.
        • Avery A.J.
        • et al.
        A comparison of the performance of the EQ-5D and SF-6D for individuals aged >or = 45 years.
        Health Econ. 2008; 17: 815-832
        • Shaw J.W.
        • Johnson J.A.
        • Coons S.J.
        US valuation of the EQ-5D health states: development and testing of the D1 valuation model.
        Med Care. 2005; 43: 203-220
        • Murphy M.
        • Sternschuss G.
        • Haff R.
        • et al.
        Quality of life and surgical satisfaction after vaginal reconstructive vs obliterative surgery for the treatment of advanced pelvic organ prolapse.
        Am J Obstet Gynecol. 2008; 198 ([e1–7]): 573
        • Research Electronic Data Capture (REDCap) Consortium
        ([accessed 17.07.16])