Metal Allergy pp 301-320 | Cite as

Hypersensitivity to Other Implants: Gynecological, Neurovascular, Oculoplastic, Nuss Bars

  • Kerry Heitmiller
  • Danielle Baruch
  • Anthony A. Gaspari
Chapter

Abstract

Gynecological, neurovascular, oculoplastic devices and Nuss bars are a diverse group of medical implants with various metal compositions. Hypersensitivity reactions to these implants have been reported and range from either nonexistent or very rare to serious adverse reactions. The epidemiology of hypersensitivity reactions to some of these implants is not well studied, with population studies lacking to define the role of predictive patch testing in preimplantation decision making. In this chapter, we present the literature that exists on these medical implants and their associations with hypersensitivity-related complications after insertion. Based on our findings, we assess the role of preoperative patch testing for each type of implant. Gynecological implants used for contraception are rarely associated with complications and do not warrant patch testing prior to insertion. Hypersensitivity reactions to neurovascular implants, while infrequent, are increasingly reported and can be associated with devastating outcomes. Therefore, preoperative patch testing may prove beneficial to certain patients, although, the predictive value of this practice is unknown, and further studies are needed to evaluate the associated clinical benefit. Gold oculoplastic implants to treat lagophthalmos rarely account for hypersensitivity reactions and, when they do occur, have been successfully treated with implant removal. Predictive patch testing is only indicated in patients with a history suggestive of gold intolerance. The stainless steel Nuss bar is used to treat pectus excavatum, and its association with hypersensitivity-related complications has been well established. There is good evidence to support preoperative patch testing for all patients undergoing the Nuss procedure and the use of a titanium Nuss bar in the setting of a nickel allergy. Hypersensitivity reactions to implanted metal devices remain a major consideration in preoperative decision making or postoperative management of patients with potential complications related to an implanted device. In reviewing the information related to hypersensitivity reactions to metal implants for these indications (gynecologic, neurovascular, oculoplastic, and pediatric), it is apparent that there is a paucity of robust epidemiologic information about the incidence of hypersensitivity reactions to metals in these implanted materials (except for the Nuss procedure). Further epidemiologic studies of patients undergoing implantations for these diverse indications are needed to better define the value of predictive patch testing.

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Kerry Heitmiller
    • 1
  • Danielle Baruch
    • 1
  • Anthony A. Gaspari
    • 1
  1. 1.Department of DermatologyUniversity of Maryland BaltimoreBaltimoreUSA

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