{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T23:22:59Z","timestamp":1763767379030,"version":"3.37.3"},"reference-count":26,"publisher":"Georg Thieme Verlag KG","issue":"04","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Eur J Pediatr Surg"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Introduction\u2003Nuss procedure is the main reason for metal implants use by pediatric and thoracic surgeons. There is an ongoing debate on how to avoid allergic complications. Herein we describe our 8-year experience with systematic preoperative metal patch testing and our selective titanium bar use in Nuss procedure.<\/jats:p><jats:p>\n          Materials and Methods\u2003This is a single center retrospective observational cohort study of patients who underwent the Nuss procedure from 2013 to 2020. Preoperative metal patch testing was done in all cases. Criteria for titanium bar utilization were: a positive test for a major component of the stainless-steel bar; or a positive metal patch test and a positive history of atopy, food or metal allergy, or previous allergic reaction to an implant or device.<\/jats:p><jats:p>\n          Results\u2003In total, 56 patients were included. Most were male (91.1%) with a median age of 15.0 (13.0\u201322.0) years old. 19.6% had a positive preoperative metal patch test and 54.5% of these had no personal history of atopy. Stainless-steel bars were used in 27.3% of those patients and titanium bars were used in 72.7%. One patient had a documented minor allergy reaction. None of the 56 patients required early bar removal.<\/jats:p><jats:p>\n          Conclusion\u2003Our study suggests that routine preoperative allergy testing and a judicious use of titanium bar are safe and avoid metal allergic complications.<\/jats:p>","DOI":"10.1055\/a-1868-6224","type":"journal-article","created":{"date-parts":[[2022,6,3]],"date-time":"2022-06-03T22:56:30Z","timestamp":1654296990000},"page":"287-292","source":"Crossref","is-referenced-by-count":2,"title":["Preoperative Metal Patch Testing and Titanium Bar Use Criteria in Nuss Procedure: A 56-Patients' Cohort Study"],"prefix":"10.1055","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5336-8760","authenticated-orcid":false,"given":"Joana","family":"Pereira-Nunes","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Centro Hospitalar Universit\u00e1rio de S\u00e3o Jo\u00e3o Ringgold Standard Institution, Porto, Porto, Portugal"},{"name":"Department of Gynecology-Obstetrics and Pediatrics, Faculty of Medicine, University of Porto, Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1000-7324","authenticated-orcid":false,"given":"Sofia","family":"Vasconcelos-Castro","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Centro Hospitalar Universit\u00e1rio de S\u00e3o Jo\u00e3o Ringgold Standard Institution, Porto, Portugal"}]},{"given":"Jos\u00e9","family":"Fontoura-Matias","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Centro Hospitalar Universit\u00e1rio de S\u00e3o Jo\u00e3o Ringgold Standard Institution, Porto, Porto, Portugal"},{"name":"Department of Gynecology-Obstetrics and Pediatrics, Faculty of Medicine, University of Porto, Porto, Portugal"}]},{"given":"Nuno","family":"Preto-Gomes","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Centro Hospitalar Universit\u00e1rio de S\u00e3o Jo\u00e3o Ringgold Standard Institution, Porto, Porto, Portugal"}]},{"given":"Ana","family":"Marinho-Cunha","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Centro Hospitalar Universit\u00e1rio de S\u00e3o Jo\u00e3o Ringgold Standard Institution, Porto, Porto, Portugal"}]},{"given":"Miguel","family":"Soares-Oliveira","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Centro Hospitalar Universit\u00e1rio de S\u00e3o Jo\u00e3o Ringgold Standard Institution, Porto, Portugal"}]}],"member":"194","published-online":{"date-parts":[[2022,10,14]]},"reference":[{"volume-title":"Pectus excavatum: Treatment","author":"O H Mayer","key":"ref1"},{"issue":"03","key":"ref2","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1053\/j.sempedsurg.2008.03.003","article-title":"Minimally invasive surgical repair of pectus excavatum","volume":"17","author":"D Nuss","year":"2008","journal-title":"Semin Pediatr Surg"},{"issue":"06","key":"ref3","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1097\/DER.0000000000000149","article-title":"Patch testing for metal allergy with manufacturer-supplied materials before Nuss bar insertion","volume":"26","author":"K Heitmiller","year":"2015","journal-title":"Dermatitis"},{"issue":"03","key":"ref4","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1016\/j.jpedsurg.2013.07.014","article-title":"High rates of metal allergy amongst Nuss procedure patients dictate broader pre-operative testing","volume":"49","author":"B Shah","year":"2014","journal-title":"J Pediatr Surg"},{"issue":"01","key":"ref5","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.jpedsurg.2006.09.056","article-title":"When it is not an infection: metal allergy after the Nuss procedure for repair of pectus excavatum","volume":"42","author":"G D Rushing","year":"2007","journal-title":"J Pediatr Surg"},{"issue":"01","key":"ref6","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1111\/j.1600-0536.2011.01971.x","article-title":"Hypersensitivity reactions to metallic implants - 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