Odom Elizabeth B, Eisenberg David L, Fox Ida K
Washington University School of Medicine, Division of Plastic and Reconstructive Surgery.
Washington University School of Medicine, Department of Obstetrics and Gynecology.
Contraception. 2017 Aug;96(2):89-95. doi: 10.1016/j.contraception.2017.05.001. Epub 2017 Jun 3.
We aim to describe our experiences and identify patients who may benefit from referral to a peripheral nerve surgeon for removal of contraceptive subdermal implants in which neurovascular injury may occur, and describe a treatment pathway for optimal care.
We reviewed the charts of 22 patients who were referred to the Division of Family Planning for difficult removal of etonogestrel contraceptive implants between January 1, 2014, and April, 1 2016. Of these, five were referred to a peripheral nerve surgeon due to pain or location of the implant. We evaluated and described these cases and, from our findings, developed recommendations for care in a multidisciplinary team approach.
Two patients reported pain, including one with four previous failed removal attempts. In the two patients with pain, the implants were adherent to a sensory nerve. In another, the implant was within the biceps muscle and difficult to locate. In all cases, ultrasound imaging, general anesthesia and a wide exposure allowed for safe removal and good outcomes. Our multidisciplinary care approach has elucidated important referral and technical considerations that improve patient care and safety.
When necessary, multidisciplinary care with a Family Planning expert and possibly a peripheral nerve surgeon may be beneficial in safely removing etonogestrel contraceptive implants that would be difficult or risky to remove in an ambulatory setting.
我们旨在描述我们的经验，确定那些可能因神经血管损伤而需要转诊至周围神经外科医生处取出皮下避孕植入物的患者，并描述最佳护理的治疗途径。
我们回顾了2014年1月1日至2016年4月1日期间转诊至计划生育科以困难取出依托孕烯避孕植入物的22例患者的病历。其中，5例因植入物疼痛或位置原因被转诊至周围神经外科医生处。我们评估并描述了这些病例，并根据我们的发现，以多学科团队方法制定了护理建议。
2例患者报告疼痛，其中1例之前有4次取出尝试失败。在这2例疼痛患者中，植入物附着于感觉神经。在另一例中，植入物位于肱二头肌内且难以定位。在所有病例中，超声成像、全身麻醉和广泛暴露使得能够安全取出并取得良好结果。我们的多学科护理方法阐明了重要的转诊和技术考虑因素，可改善患者护理和安全性。
必要时，由计划生育专家以及可能的周围神经外科医生进行多学科护理，对于安全取出在门诊环境中取出困难或有风险的依托孕烯避孕植入物可能有益。
