Subfascial-located contraceptive devices requiring surgical removal

Area of Science:

• Contraception
• Upper Extremity Surgery
• Medical Device Complications

Background:

• Subdermal etonogestrel implants are effective contraceptives.
• Improper insertion can lead to deep placement within or below the biceps brachii fascia.
• Deeply placed implants present removal challenges, sometimes requiring surgical intervention.

Purpose of the Study:

• To report on cases of etonogestrel implants requiring surgical removal due to deep placement.
• To highlight the role of upper extremity surgeons in managing these complications.

Main Methods:

• Retrospective review of 6 cases requiring surgical implant removal.
• Pre-operative localization using radiography and ultrasound.
• Surgical removal under monitored anesthesia care or regional anesthesia.

Main Results:

• All 6 implants were successfully removed surgically.
• Implants were located in the subfascial plane, with one intramuscularly.
• The primary indication for removal was irregular bleeding.

Conclusions:

• Deep placement of etonogestrel implants is a rare but serious complication.
• Office-based removal may not always be feasible, necessitating referral.
• Surgical removal by specialists is crucial to prevent neurovascular damage.