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Birth control implant in arm removal side effects

Birth control implant removal in arm
Birth control implant removal is a simple procedure. The insertion and removal of implant is commonly performed in a gynecology clinic outpatient setting.

A doctor marks the spot on your arm where the implant is, then he cleans the area to prevent infection. After that, he gives you a local anaesthesia into a small area of the skin of the arm. After that, he makes a small incision to remove the implant. It will not be painful when he makes the incision or during implant removal. You’ll need to Wear a bandage for 48 hour and keep the area dry for 48 hours. The arm may be sore after implant removal. 

Birth control implant side effects 
Birth control implant in arm are commonly used for long-acting birth control in the world. It is relatively safe in nature. But sometimes implantation and removal may be associated with possible  complications. Complications include migration, incorrect implantation, infection, or difficult removal. Proximal migration has been reported. There is a case report of implant that has migrated within the brachial neurovascular sheath and required surgical removal.

Birth control implant removal difficulty 
It could be difficult to remove it and may take 20 minutes or longer if there’s a lot of scar tissue around it. If there is a difficulty in removal of the implant and your doctor can not easily find it, he may take an X-ray arm antroposterior and lateral views  to locate it. 
 
Case presentation 

Figure 1. AP and lateral X ray views of the left humerus show the location of birth control implant 
Figure 2. C arm assessed removal of the implant 

Figure 3. An intraoperative photo shows the birth control implant that is completely removed without fragmentation. 

A healthy, 25 years old woman underwent an insertion of a birth control implant to
her left arm in the gynecology outpatient clinic. Six months after insertion, she began experiencing, severe insomnia, headache and pruritus. These symptoms were persistant for 3 weeks. She presented to her gynecology doctor requesting birth control implant removal. An attempt was made for implant removal in the outpatient clinic under local anesthesia, with direct palpation through the previous arm incision that was used to insert the implant; however, he failed to remove it. The following day, the patient presented to a general surgery doctor for a second attempt. X ray AP and Lateral views were done. The implant was not be located at the site of its original insertion. It was found to have migrated in the arm. 

The trials to remove the implant were stopped, and an orthopedic surgeon was consulted. Radiographs obtained confirmed migration of the implant.
The implant was not palpable in the subcutaneous tissue. The physical examination was done and showed no loss of neurological function and the radial pulsation was intact. 

Decision was made for wound exploration  and implant removal from the arm in the operating room, this time with the aid of C-arm fluoroscopy. In the operating room, the wound in the arm was lengthened longitudinally to a length of 2.5 cm. Careful dissection was carried down 
distal tip of the implant was visualized. The implant was palpable and the implant  was removed without complications. Complete implant removal was confirmed with C-arm.

Follow-up was done for 2 weeks after the implant removal, the wound had healed without complications and the
neuro-vascular examination was normal.

Discussion 
Incidence 
Birth control implant is the most effective form of birth control and lasts up to 3 years. It has a 0.05% failure rate. That means 5 in 10,000 women using this implant will become pregnant in a year.
One percent of American women using birth control methods utilize an etonogestrel single rod implant.

Location of insertion in the arm
 It is nserted eight to ten cm proximal to the medial epicondyle of the distal humerus with a disposable applicator. Later, it is removed with direct palpation and local anesthesia in an outpatient clinic. 

Implant removal complications
Implant removal complications with implant have been reported in up to five percent of cases. The majority of them are due to submuscular placement and implant migration, both result in difficult removal. Inability to palpate the device include fibrosis of the implant and failure of insertion.

Radiological measurements to locate the implant 
New implants used in have added radiopaque features allowing for visualization with x-ray imaging to locate the implant if it cannot be palpated at the time of removal. Other methods for localization include utilization of ultrasound or magnetic resonance imaging.

Birth control implant removal in the operating room 
A need to recover the implant in the operating room is very rare, but has been reported. 

Other reported cases
Vidin et al reported 28 cases of implant removal in the operating room over a three years period. Three of the 28 patients were in a perivascular location. In our case, inability to visualize the implant with exploration in the outpatient clinic setting, removal in the operating room was
indicated. When birth control implant 
cannot be palpated, there is possible migration. Then, x ray imaging to confirm the location and consideration of removal in the operating room.

Reference 

1- Vidin E, Garbin O, Rodriquez B, Favre R, Bettahar-Lebugle K.
Removal of etonogestrel contraceptive implants in the operating room
theater: report on 28 cases. Contraception. 2007;76(1):35e39.

2- Belyea C, Ernat J, Gumboc R. Removal of a Contraceptive Implant From the Brachial Neurovascular Sheath. J Hand Surg Am. 2017 Feb;42(2):e115-e117. doi: 10.1016/j.jhsa.2016.10.013. Epub 2016 Nov 23. PMID: 27889093.



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