Dados do Trabalho

Título

Neuropatia compressiva do nervo radial por prótese de silicone

RESUMO

Case report
MFV, 26 years old, female, past bariatric surgery on 01/2010, current plastic surgery for placement of silicone prostheses (breasts, gluteus, calves, arms: biceps and triceps) on 10/2010.
The patient evolved with loss of motor strength in left wrist extension/left wrist drop (0/5 strength) with preservation of elbow extension.
An MRI was performed, identifying the well-positioned prostheses, except for one in the left arm, which maintains close contact with the radial nerve between the triceps heads. Furthermore an electroneuromyography on 09/01/2010 which showed a severe, but partial axonal mononeuropathy of the left radial nerve in the arm (axonotmesis).
She underwent surgery to remove the prostheses on 11/2010, in which the anatomical integrity of the nerve was identified with a weak response to intraoperative electrical stimulation. There was full functional recovery after 1 year of rehabilitation.
Discussion
Silicone implants have been used in Medicine for over 60 years. Historically, interest in aesthetic procedures to alter body contour has increased greatly during the 1980s due to the popularization of body building as a sport and the fitness culture¹. Since the beginning of the century, due to the increasing accessibility of information about the procedures a new rising wave of demand for silicone implants for body contouring has been installed¹. In particular, prostheses for previously unexplored areas are gaining more and more space, as is the case of implants to increase the biceps and triceps¹²³.
Despite the relative scarcity of data and publications⁴, the most expected complications in upper limb implants include local infection, seroma, implant extrusion, asymmetry, compartment syndrome, muscle and nerve damage, with neuropraxia being the most common immediate complication¹³. In agreement with the reports in the literature, the present case presented neuropathy as a result of the implant performed in the posterior region of the arm. The triceps is innervated by the radial nerve. Radial nerve damage can occur either from intraoperative damage during dissection of the muscle or from compression by positioning the prosthesis.
Final comments
Currently available data on complication rates in cosmetic procedures for upper limb implants are scarce and in small samples, ranging from 26.7%² to 47.6%⁴ - the latter encompassing only biceps implants. Further studies about complications of implants are necessary.

Palavras Chave

RADIAL NERVE, SILICON PROSTHESIS, NERVE INJURY

Área

Neuropatias Periféricas