Walking the Tight Rope for a Diagnosis: A Case Report of a Dermatological Enigma of Surgical Device Nickel Allergy

Metal allergies pose challenges in patients with implantable devices, yet no standardized protocols exist for preoperative metal patch testing. This case details a 53-year-old woman with systemic dermatitis and impaired hand function after left thumb trapeziectomy with Arthrex Mini TightRope placement. Despite treatment, including hardware removal, symptoms including rash, pruritus, and impaired mobility persisted for months. Metal patch testing confirmed hypersensitivity to nickel, chromium, and other metals, implicating type IV hypersensitivity. Nickel is the most common allergen, affecting up to 20% of the population, yet clinical guidelines for managing implant-related hypersensitivity are lacking. This report underscores the critical role of perioperative nursing in comprehensive preoperative screening, including obtaining a detailed history of metal sensitivities, educating patients on potential risks, and facilitating multidisciplinary collaboration with dermatology and immunology specialists. Future research should explore the immunopathology of metal hypersensitivity and develop evidence-based nursing protocols and interdisciplinary strategies to reduce adverse outcomes and improve patient safety.