Dermatitis in patients undergoing the Nuss procedure for correction of pectus excavatum

Aneja, Savina; Taylor, James S.; Soldes, Oliver S.; DiFiore, John W.

doi:10.1111/j.1600-0536.2011.01966.x

Cited by 23 publications

(16 citation statements)

References 22 publications

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“…16 Two patients with Nuss bars were included in another publication. 17 Statistical analysis was performed using 1-sided Fisher exact tests to calculate the association between self-reported history of hypersensitivity to metals and positive results of patch testing for hypersensitivity to metals.…”

Section: Methodsmentioning

confidence: 99%

The Effect of Patch Testing on Surgical Practices and Outcomes in Orthopedic Patients With Metal Implants

et al. 2012

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To determine the effect of patch testing on surgical decision making and outcomes in patients evaluated for suspected metal hypersensitivity related to implants in bones or joints. Design: Medical chart review. Setting: Tertiary care academic medical center. Participants: All patients who had patch testing for allergic contact dermatitis related to orthopedic implants. Intervention: Patch testing. Main Outcome Measures: The surgeon's preoperative choice of metal implant alloy compared with patch testing results and the presence of hypersensitivity complications related to the metal implant on postsurgical follow-up. Results: Patients with potential metal hypersensitivity from implanted devices (N=72) were divided into 2 groups depending on timing of their patch testing: preimplantation (n=31) and postimplantation (n=41). History of hypersensitivity to metals was a predictor of positive patch test results to metals in both groups. Positive patch test results indicating metal hypersensitivity influenced the decisionmaking process of the referring surgeon in all preimplantation cases (n=21). Patients with metal hypersensitivity who received an allergen-free implant had surgical outcomes free of hypersensitivity complications (n=21). In patients who had positive patch test results to a metal in their implant after implantation, removal of the device led to resolution of associated symptoms (6 of 10 patients). Conclusions: The findings of this study support a role for patch testing in patients with a clinical history of metal hypersensitivity before prosthetic device implantation. The decision on whether to remove an implanted device after positive patch test results should be made on a case-bycase basis, as decided by the surgeon and patient.

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Section: Methodsmentioning

confidence: 99%

The Effect of Patch Testing on Surgical Practices and Outcomes in Orthopedic Patients With Metal Implants

et al. 2012

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“…Like contact dermatitis, every patients’ reaction to the metal is highly individual. A large number of individuals, even nickel-sensitized patients, will tolerate low levels of metals in implants without developing a reaction [8]. …”

Section: Discussionmentioning

confidence: 99%

“…These reactions occur in 6–8% of the cases and have been attributed to an allergic reaction to the metal bars implanted [7, 8]. However, some patients have developed these symptoms despite a negative preoperative skin test [7–9].…”

Section: Introductionmentioning

confidence: 99%

Trace metal release after minimally-invasive repair of pectus excavatum

et al. 2017

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BackgroundSeveral studies have shown a high incidence of metal allergy after minimally-invasive repair of pectus excavatum (MIRPE). We postulated that MIRPE is associated with a significant release of trace metal ions, possibly causing the allergic symptoms.MethodsWe evaluated the concentration with chromium, cobalt and nickel in blood, urine and tissue in patients prior to MIRPE and in patients who underwent an explantation of the stainless-steel bar(s) after three years.ResultsOur study group consisted of 20 patients (mean age 19 years) who had bar explantation and our control group included 20 patients (mean age 16 years) prior to MIRPE. At the time of bar removal we detected significantly elevated concentrations of chromium and nickel in the tissue compared to patients prior to the procedure (p<0,001). We also found a significant increase in the levels of chromium in urine and nickel in blood in patients three years post MIRPE (p<0,001). Four patients temporarily developed symptoms of metal allergy, all had elevated metal values in blood and urine at explantation.ConclusionsMinimally-invasive repair of pectus excavatum can lead to a significant trace metal exposure.

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“…An incidence of 2.8% (35 patients) of Bar Allergy was reported in a case series of 1,215 patients having a Nuss procedure (22) of which three patients had to be re-operated to have their bar removed. Some institutions have instituted pre-operative allergy testing in high-risk patients prior to surgery (23). Patients with prior nickel allergy can have titanium bars to avoid hypersensitivity; Preoperative assessment clinic also provides an ideal opportunity for patient education, discussions related to the anaesthetic approach, risks and benefits of proposed postoperative analgesic regime, and consent for invasive and semi-invasive monitoring such as arterial cannulation or transesophageal echocardiography (TOE).…”

Section: Preoperative Anaesthetic Assessmentmentioning

confidence: 99%

Anaesthetic considerations for pectus repair surgery

Patvardhan

Martínez

2016

J. Vis. Surg.

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Repair of pectus is one of the most common congenital abnormality for which patient presents for thoracic surgery. In recent years, innovative minimally invasive techniques involving video assisted thoracoscopy for pectus repair have become the norm. Similarly, anaesthetic techniques have evolved to include principles of enhanced recovery, multimodal analgesia and innovative ultrasound guided neuraxial and nerve blocks. Adequate anaesthetic set up and monitoring including the use of real time intraoperative monitoring with transesophageal echocardiography (TOE) has enabled the anaesthetist to enhance patient safety by providing instantaneous imaging of cardiac compression and complications during surgery. In this review article we aim to provide non-systematic review and institutional experience of our anaesthetic strategy to provide effective peri-operative care in this patient group.

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Dermatitis in patients undergoing the Nuss procedure for correction of pectus excavatum

Abstract: Despite clinical evidence of cutaneous reactions or putative allergy, no patient required early removal of the bar(s). Cutaneous testing with stainless steel discs supplied by the bar manufacturer does not provide accurate screening for allergy to the implant used in the Nuss procedure.

Cited by 23 publications

References 22 publications

The Effect of Patch Testing on Surgical Practices and Outcomes in Orthopedic Patients With Metal Implants

The Effect of Patch Testing on Surgical Practices and Outcomes in Orthopedic Patients With Metal Implants

Trace metal release after minimally-invasive repair of pectus excavatum

Anaesthetic considerations for pectus repair surgery

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