Metal allergy after the Nuss procedure for pectus excavatum: a review

Abstract

Minimally invasive repair of pectus excavatum (MIRPE) technique (the Nuss procedure) is a minimally-invasive method that is commonly used in the treatment of pectus excavatum. An allergic reaction to the metal alloy bar that is implanted in the thorax during the procedure is a reported complication. We briefly review current literature concerning epidemiology, mechanisms and research results of allergic reactions after Nuss bar implantation. This allergic reaction occurs in approximately 2.7% of patients and is caused by metals used in the medical implant. The most common symptoms include fever and skin lesions such as allergic dermatitis. Elevated levels of C-reactive protein is a frequent finding in laboratory tests. In order to minimize the risk of such complications, taking a detailed allergy-based medical history and conducting allergy tests, i.e. patch test are required. Allergic reactions can be managed with conservative treatment such as general or topical glucocorticosteroid therapy and antihistamine agents. Severe allergic reactions can be addressed by implant revision, replacement of the steel bar with a titanium substitute or removal of the stabilization at all. Although the risk of an allergic reaction to titanium is smaller it still exists, the titanium substitute is not routinely used due to its higher cost and lesser plasticity which has a negative impact on matching a stabilizing bar during the surgery. Surgeons treating pectus excavatum should remember about the possible allergic reactions after implantation of the metal bar and be familiar with methods of diagnosis and treatment of those complications.

Skin reaction after pectus surgery

“…Although bars containing metals such as nickel and chromium, which may cause allergic reactions, are used in surgery, it should be kept in mind that the contact of the metal bar with the skin and skin tension may also cause skin reaction. Although it has been reported in the literature that metal allergy is 10% in the general population, the complication rate defined as bar allergy in pectus excavatum series has been reported to be between 0.5% and 6.4% [2]. While this rate was 5% in the authors' study, it was 3.1% for pectus excavatum and 8% for pectus carinatum according to our experience [1,3].…”

Short-term and mid-term effects of thoracoscopic repair of esophageal atresia: No anastomotic leaks or conversions to open technique

“…The secondary objective was the risk factors analysis in the context of short-term and mid-term follow-up status. With our experience in minimally invasive surgery (15)(16)(17)(18), we present our data showing that outcome in terms of surgery-dependent morbidity of patients with EA treated with thoracoscopic method might improve previously reported results (Table 1) (5,6,(19)(20)(21)(22)(23) in the context of a lower rate of leakage and other complications, such as conversion to open surgery, regardless of the prognostic criteria of the classification system.…”

Preoperative Metal Patch Testing and Titanium Bar Use Criteria in Nuss Procedure: A 56-Patients' Cohort Study

“…19 In our cohort, 19.6% patients presented a positive preoperative metal patch test, which was higher than the 10 to 15% reported in the general population for standard nickel, cobalt, and chromium series. 8,20 Most of the positive patients (54.6%) did not have personal atopy history and none had a personal or family history of metal allergy or previous reaction to an implant. Our extended preoperative series may have an important contribution for this higher prevalence.…”