Case Report
Nerve injury caused by removal of an implantable hormonal contraceptive

https://doi.org/10.1016/j.ajog.2005.09.016Get rights and content

Implanon insertion and removal are relatively uncomplicated procedures in the hands of medical professionals familiar with the technique. However, injury to branches of the medial antebrachial cutaneous nerve during Implanon insertion and removal can result in impaired sensibility, severe localized pain, or the formation of painful neuroma that can be quite devastating to the patient. The best way to avoid injury to the medial antebrachial cutaneous nerve is to better understand its position relative to the standard area of Implanon insertion. In the event that an injury to the nerve is recognized, immediate plastic surgical measures should be undertaken to avoid displeasing sequels of nerve injuries. Therefore, the benefit of this generally well-tolerated, highly effective, and relatively cost-efficient contraception is guaranteed only in the hands of medical professionals familiar with the technique.

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Case report

A 24-year-old woman was referred to our unit for removal of a previously implanted hormonal contraceptive after her gynecologist had attempted removal without success. The patient presented with paresthesia of the proximal ulnar forearm with a dimension of 10 to 7 cm (Figure 1) and an impalpable implant. Paresthesia was noticed by the patient immediately after the operative intervention. Ultrasound examination revealed the exact location of the nonpalpable Implanon and no evidence of nerve

Anatomy

The compact, dense brachial fascia encloses the muscles of the upper arm and superficial location of this fascia the subcutaneous vessels, nerves, and the lymphatic vessels are situated.

The basilic vein breaks through the brachial fascia at the basilic hiatus in accompaniment of the medial antebrachial cutaneous nerve. The basilic hiatus and so the medial antebrachial cutaneous nerve are located in the distal part of the well-palpable medial bicipital groove, which is confined by the biceps,

Comment

Implanon, a progestin-only contraceptive implant with a Pearl index of 0, is an extremely effective, economical, and convenient alternative to oral or intrauterine contraceptives.1 Usually insertion and removal are relatively uncomplicated procedures1, 2 in the hands of medical professionals who are familiar with the techniques, and the main adverse event causing discontinuation of implants is a change in bleeding pattern.3 Further reported adverse effects of Implanon are weight gain, acne,

Conclusion

The simple handling of the insertion instruments, the minimal incision size, and the absence of sized anatomical structures on the medial part of the upper arm should not entice unversed surgeons to perform this operation unwarily. The benefit of this generally well-tolerated, highly effective, and relatively cost-efficient contraception is guaranteed only in the hands of medical professionals familiar with the technique and anatomy of this region. The implantation area should be reconsidered.

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