Metal allergy as a late‐onset complication of the Nuss procedure in a pediatric patient

Navratil, Marta; Batinica, Maja; Ivković‐Jureković, Irena

doi:10.1002/ppul.24072

Cited by 4 publications

(3 citation statements)

References 5 publications

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“…When there is no improvement after the pharmacological treatment, the metal bar should be replaced with a titanium substitute. Many patients, in spite of confirmed hypersensitivity, do not manifest any side effects due to the metal bar presence [4,6,13,16,22].…”

Section: Mechanismmentioning

confidence: 99%

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

Gałązka¹,

Leis²,

Kroczek³

et al. 2020

pdia

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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.

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Section: Mechanismmentioning

confidence: 99%

“…Despite the high efficiency and minimal invasiveness in comparison to the alternative methods (i.e. the Ravitch technique), the MIRPE technique carries the risk of side effects of an allergic reaction to metal [1][2][3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

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

Gałązka¹,

Leis²,

Kroczek³

et al. 2020

pdia

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show abstract

“…Nonetheless, the tissue trace metal contamination has to be much higher at this early timepoint because it is directly exposed to the stainless steel, leading to these local reactions. In the other reports, the irritative reactions occurred in a similar timeframe of up to 40 days after MIRPE [ 2 , 16 ]; however, two other groups reported allergic reactions up to nine months after MIRPE [ 17 , 18 ]. Release of trace metal ions at a slower pace could lead to these late reactions.…”

Section: Discussionmentioning

confidence: 92%

Nickel contamination after minimally-invasive repair of pectus excavatum persists after bar removal

Fortmann

Göen²,

Zinne³

et al. 2022

PLoS ONE

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Background Minimally-invasive repair of pectus excavatum (MIRPE) has been shown to be associated with high release of trace metals into patient’s body. The aim of our study was to analyze the kinetics of metal contamination after MIRPE and after bar removal. Methods We prospectively assessed nickel and chromium changes in blood, urine, and local tissue in patients undergoing MIRPE with stainless-steel bar(s). Baseline samples were taken prior to surgery, further samples were taken at six defined time points until 30 months after bar removal. Clinical symptoms were evaluated at the time of every sample collection. Results 28 patients were included (mean age 16.4 years). At four weeks after MIRPE and persisting up to bar removal, we found significantly elevated trace metal levels in blood and urine. Tissue nickel and chromium levels were significantly elevated at the time of bar removal. After bar removal, the concentration of trace metal in urine and the concentration of chromium in plasma decreased gradually. In contrast, nickel levels in blood further increased. Five patients showed irritative symptoms after MIRPE, all symptomatic patients had elevated metal levels. Conclusions Following MIRPE, we found a rapid systemic increase of nickel and chromium. Our data indicate that trace metal release could cause irritative symptoms. The prolonged elevated systemic nickel levels beyond bar removal necessitate further investigations of the long-term side effects of MIRPE.

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Post‐operative arrest following pectus excavatum repair: A case report with a systematic review of the published case reports

Roostaei,

Amini,

Abtahi

et al. 2024

Clinical Case Reports

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Key Clinical MessageCommon complications after PE surgery include ventricular tachycardia, cardiac arrest, pneumothorax, and bar displacement. These can lead to severe outcomes, emphasizing the need for caution and meticulous post‐operative monitoring. Patients and their families should be well‐informed about potential risks during the consent process.AbstractThe objective of this study was to raise awareness among medical staff and surgeons about potential complications, particularly rare and life‐threatening ones, associated with pectus excavatum (PE) surgery. PE is the most common chest wall deformity, characterized by sternal depression. Patients primarily seek treatment for cosmetic concerns, but some also report exercise intolerance and shortness of breath. Although surgical repair is the standard treatment, the incidence and nature of severe complications remain unclear and underreported. This study presents a case of a lethal cardiac event following PE surgery and conducts a systematic review of published case reports. This study describes a case of a lethal complication of ventricular fibrillation and cardiac arrest following the Ravitch procedure for correction of PE in a 10‐year‐old boy. A systematic review of relevant cases of PE surgery complications was conducted. Of the 506 initial records retrieved, 93 case reports from 83 articles were identified over the 23 years. Among them, 72 patients were male, and 20 cases were female. The average age of patients was 19.2 ± 7.7 years (range: 5–53). Complications had occurred up to 37 years from the time of surgery, with most of the cases (22.5%) occurring during the operation. The most frequent complications included cardiothoracic issues and displacement of the implanted steel bar. In nine patients, complications led to fatal outcomes. Due to the possible risks of PE surgery, particularly in cosmetically motivated cases, surgeons must exercise extreme caution and remain vigilant for rare and potentially life‐threatening complications.

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Metal allergy as a late‐onset complication of the Nuss procedure in a pediatric patient

Cited by 4 publications

References 5 publications

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

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

Nickel contamination after minimally-invasive repair of pectus excavatum persists after bar removal

Post‐operative arrest following pectus excavatum repair: A case report with a systematic review of the published case reports

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