Peripheral Nerve Injury associated with a Subdermal Contraceptive Implant: Illustrative Cases and Systematic Review of Literature.

Peripheral Nerve Injury associated with a Subdermal Contraceptive Implant: Illustrative Cases and Systematic Review of Literature.

World Neurosurg. 2018 Jan 05;:

Authors: Laumonerie P, Blasco L, Tibbo ME, Leclair O, Kerezoudis P, Chantalat E, Mansat P

Abstract
BACKGROUND: Despite the demonstrable safety and efficacy of subdermal contraceptive implants (SCI), both insertion and removal of SCI in the arm have been associated with neurovascular complications. The primary aim of this study is to investigate the type and prognosis of nerve injuries associated with SCI.
METHODS: The authors performed a comprehensive search of 4 electronic databases for studies pertaining to patients with nerve injury and concurrent SCI. Studies published between January 1987 and June 2017 were included. Implant location, damaged nerve(s), clinical presentation, preoperative imaging (X-rays, ultrasound, MRI), neurologic evaluation (nerve conduction studies and electromyography), and treatment methods were reviewed. To outline management strategies, 2 illustrative cases of major nerve injury caused by implant removal were presented.
RESULTS: A total of 10 studies including 12 patients were analyzed. Fourteen nerve injuries were reported during SCI insertion (n=1) and removal (n=11). The medial antebrachial cutaneous (n=5) and median (n=5) nerves were primarily affected. Neuropathic pain was the main symptom. The primary reasons for nerve injury were pulling or grasping of the nerve (n=9) after mistaking it for the implant. Neurapraxia (n=7) was the most common lesion and was treated with implant removal and clinical surveillance (n=6). Overall, 5 patients completely recovered, while the remaining continued to have a motor and/or sensory deficit at mean follow-up of 0.7 years (range, 0-2).
CONCLUSIONS: Nerve injuries related to SCI are rare and potentially serious. For non-palpable implants, a multidisciplinary approach, including practitioners with experience in the treatment of peripheral nerve injuries, is invaluable.

PMID: 29309985 [PubMed - as supplied by publisher]

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