Long-term Observation of Respiratory Function After Unilateral Phrenic Nerve and Multiple Intercostal Nerve Transfer for Avulsed Brachial Plexus Injury

Neurosurgery ◽  
2012 ◽  
Vol 70 (4) ◽  
pp. 796-801 ◽  
Author(s):  
Mou-Xiong Zheng ◽  
Yan-Qun Qiu ◽  
Wen-Dong Xu ◽  
Jian-Guang Xu
Keyword(s):  
Pulmonary Function ◽  
Brachial Plexus ◽  
Phrenic Nerve ◽  
Respiratory Function ◽  
Nerve Transfer ◽  
Intercostal Nerve ◽  
Adult Patients ◽  
Significant Difference ◽  
Intercostal Nerves

Abstract BACKGROUND: Phrenic nerve transfer (PNT) or multiple intercostal nerve transfer (MIT) alone are reported to have no significant impact on pulmonary function in the short or medium term, but it has rarely been reported whether the combination of PNT-MIT could influence respiratory function in the long term. OBJECTIVE: Respiratory function was evaluated after PNT and PNT-MIT 7 to 19 years (mean, 10 years) postoperatively. METHODS: Twenty-three adult patients with brachial plexus avulsion injuries who underwent PNT-MIT were compared with 19 corresponding patients who underwent PNT. Pulmonary function testings, phrenic nerve conduction study, and chest fluoroscopy were performed. In the PNT-MIT group, further investigation was performed on the effect of the number of transferred intercostal nerves and the timing of MIT. RESULTS: In the PNT-MIT group, forced vital capacity, forced expiratory volume in one second, and total lung capacity were 73.69%, 72.04%, and 74.81% of predicted values without significant differences from the PNT group. Diaphragmatic paralysis permanently existed with 1 to 1.5 intercostal spaces (ICSs) elevation and near 1 ICS reduced excursion. There was no statistical difference between the PNT and PNT-MIT groups. Furthermore, 3 and 4 intercostal nerves transferred resulted in no further decrease in pulmonary function test results than 2 intercostal nerves. No significant difference was found when PNT and MIT were performed at the same stage or with an interval. CONCLUSION: PNT-MIT did not result in additional impairment in respiratory function in adult patients compared with PNT alone. It is safe to transfer 2 to 4 intercostal nerves at 1 to 2 months delay after PNT.

Pulmonary and Biceps Function after Intercostal and Phrenic Nerve Transfer for Brachial Plexus Injuries

2004 ◽  
Vol 29 (1) ◽  
pp. 8-11 ◽  
Author(s):  
P. CHALIDAPONG ◽  
K. SANANPANICH ◽  
J. KRAISARIN ◽  
C. BUMROONGKIT
Keyword(s):  
Pulmonary Function ◽  
Brachial Plexus ◽  
Phrenic Nerve ◽  
Vital Capacity ◽  
Randomized Study ◽  
Nerve Transfer ◽  
Intercostal Nerve ◽  
Forced Expiratory Volume ◽  
Motor Recovery ◽  
Transfer Group

This pseudo-randomized study was performed to compare the pulmonary function and biceps recovery after intercostal (19 cases) and phrenic (17 cases) nerve transfer to the musculocutaneous nerve for brachial plexus injury patients with nerve root avulsions. Pulmonary function was assessed pre-operatively and postoperatively by measuring the forced vital capacity, forced expiratory volume in 1 second, vital capacity, and tidal volume. Motor recovery of biceps was serially recorded. Our results revealed that pulmonary function in the phrenic nerve transfer group was still significantly reduced 1 year after surgery. In the intercostal nerve transfer group, pulmonary function was normal after 3 months. Motor recovery of biceps in the intercostal nerve group was significantly earlier than that in phrenic nerve group. We conclude that pulmonary and biceps functions are better after intercostal nerve transfer than after phrenic nerve transfer in the short term at least.

Outcome after transfer of intercostal nerves to the nerve of triceps long head in 25 adult patients with total brachial plexus root avulsion injury

2013 ◽  
Vol 118 (3) ◽  
pp. 606-610 ◽  
Author(s):  
KaiMing Gao ◽  
Jie Lao ◽  
Xin Zhao ◽  
YuDong Gu
Keyword(s):  
Brachial Plexus ◽  
Phrenic Nerve ◽  
Nerve Transfer ◽  
Effective Rate ◽  
Root Avulsion ◽  
Factors Affecting ◽  
Triceps Muscle ◽  
Significant Difference ◽  
Long Head ◽  
Intercostal Nerves

Object The intercostal nerves (ICNs) have been used to repair the triceps branch in some organizations in the world, but the reported results differ significantly. The effect of this procedure requires evaluation. Thus, this study aimed to evaluate the outcome of ICN transfer to the nerve of the long head of the triceps muscle and to determine the factors affecting the outcome of this procedure. Methods A retrospective review was conducted in 25 patients with global root avulsion brachial plexus injuries who underwent ICN transfer. The nerves of the long head of the triceps were the recipient nerves in all patients. The ICNs were used in 2 different ways: 2 ICNs were used as donor nerves in 18 patients, and 3 ICNs were used in 7 patients. The mean follow-up period was 5.6 years. Results The effective rate of motor recovery in the 25 patients was 56% for the function of the long head of the triceps. There was no significant difference in functional recovery between the patients with 2 or 3 ICN transfers. The outcome of this procedure was not altered if combined with phrenic nerve transfer to the biceps branch. Patients in whom surgery was delayed 6 months or less achieved better results. Conclusions The transfer of ICNs to the nerve of long head of the triceps is an effective procedure for treating global brachial plexus avulsion injuries, even if combined with phrenic nerve transfer to the biceps branch. Two ICNs appear to be sufficient for donation. The earlier the surgery is performed, the better are the results achieved.

The Effect of Unilateral Intercostal Nerve Transfer upon Lung Function

1995 ◽  
Vol 20 (5) ◽  
pp. 675-676 ◽  
Author(s):  
G. E. B. GIDDINS ◽  
N. KAKKAR ◽  
J. ALLTREE ◽  
R. BIRCH
Keyword(s):  
Lung Function ◽  
Brachial Plexus ◽  
Phrenic Nerve ◽  
Respiratory Function ◽  
Nerve Palsy ◽  
Nerve Transfer ◽  
Intercostal Nerve ◽  
Phrenic Nerve Palsy ◽  
Respiratory Dysfunction ◽  
Nerve Transfers

Intercostal nerve transfer is a well-established technique in the treatment of some severe brachial plexus lesions in adults. There is, however, concern that in the presence of an ipsilateral phrenic nerve palsy it may lead to a significant compromise of respiratory function. 20 patients having intercostal nerve transfers had their lung function assessed pre-operatively and 6 weeks postoperatively. The patients were subsequently questioned about symptoms of respiratory dysfunction. There was no evidence that intercostal nerve transfer leads to a significant reduction in respiratory function in adults. It therefore appears safe to perform intercostal nerve transfers in adults following brachial plexus injuries even in the presence of an ipsilateral phrenic nerve palsy.

Comparison Between Supraclavicular Versus Video-Assisted Intrathoracic Phrenic Nerve Section for Transfer in Patients With Traumatic Brachial Plexus Injuries: Case Series

2020 ◽  
Vol 19 (3) ◽  
pp. 249-254
Author(s):  
Mariano Socolovsky ◽  
Marcio de Mendonça Cardoso ◽  
Ana Lovaglio ◽  
Gilda di Masi ◽  
Gonzalo Bonilla ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Phrenic Nerve ◽  
Case Series ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Nerve Section ◽  
Video Assisted ◽  
Significant Difference ◽  
Flexion Strength

Abstract BACKGROUND The phrenic nerve has been extensively reported to be a very powerful source of transferable axons in brachial plexus injuries. The most used technique used is supraclavicular sectioning of this nerve. More recently, video-assisted thoracoscopic techniques have been reported as a good alternative, since harvesting a longer phrenic nerve avoids the need of an interposed graft. OBJECTIVE To compare grafting vs phrenic nerve transfer via thoracoscopy with respect to mean elbow strength at final follow-up. METHODS A retrospective analysis was conducted among patients who underwent phrenic nerve transfer for elbow flexion at 2 centers from 2008 to 2017. All data analysis was performed in order to determine statistical significance among the analyzed variables. RESULTS A total of 32 patients underwent supraclavicular phrenic nerve transfer, while 28 underwent phrenic nerve transfer via video-assisted thoracoscopy. Demographic characteristics were similar in both groups. A statistically significant difference in elbow flexion strength recovery was observed, favoring the supraclavicular phrenic nerve section group against the intrathoracic group (P = .036). A moderate though nonsignificant difference was observed favoring the same group in mean elbow flexion strength. Also, statistical differences included patient age (P = .01) and earlier time from trauma to surgery (P = .069). CONCLUSION Comparing supraclavicular sectioning of the nerve vs video-assisted, intrathoracic nerve sectioning to restore elbow flexion showed that the former yielded statistically better results than the latter, in terms of the percentage of patients who achieve at least level 3 MRC strength at final follow-up. Furthermore, larger scale prospective studies assessing the long-term effects of phrenic nerve transfers remain necessary.

Long-Term Outcome of Phrenic Nerve Transfer in Brachial Plexus Avulsion Injuries

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Tarek Abdalla El-Gammal ◽  
Amr El-Sayed ◽  
Mohammed M. Kotb ◽  
Usama Farghaly Abdel-Hamid ◽  
Yousif Tarek El-Gammal
Keyword(s):  
Brachial Plexus ◽  
Phrenic Nerve ◽  
Nerve Transfer ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Brachial Plexus Avulsion

Anatomic study of the intercostal nerve transfer to the suprascapular nerve and a case report

2013 ◽  
Vol 39 (2) ◽  
pp. 194-198 ◽  
Author(s):  
S. Hu ◽  
B. Chu ◽  
J. Song ◽  
L. Chen
Keyword(s):  
Case Report ◽  
Brachial Plexus ◽  
External Rotation ◽  
Nerve Transfer ◽  
Suprascapular Nerve ◽  
Intercostal Nerve ◽  
Accessory Nerve ◽  
Shoulder Abduction ◽  
Anatomical Basis ◽  
Intercostal Nerves

The purpose of this study was to investigate the anatomical basis of intercostal nerve transfer to the suprascapular nerve and provide a case report. Thoracic walls of 30 embalmed human cadavers were used to investigate the anatomical feasibility for neurotization of the suprascapular nerve with intercostal nerves in brachial plexus root avulsions. We found that the 3rd and 4th intercostal nerves could be transferred to the suprascapular nerve without a nerve graft. Based on the anatomical study, the 3rd and 4th intercostal nerves were transferred to the suprascapular nerve via the deltopectoral approach in a 42-year-old man who had had C5-7 root avulsions and partial injury of C8, T1 of the right brachial plexus. Thirty-two months postoperatively, the patient gained 30° of shoulder abduction and 45° of external rotation. This procedure provided us with a reliable and convenient method for shoulder function reconstruction after brachial plexus root avulsion accompanied with spinal accessory nerve injury. It can also be used when the accessory nerve is intact but needs to be preserved for better shoulder stability or possible future trapezius transfer.

scholarly journals Nerve Transfers for Restoring Elbow Flexion in Brachial Plexus Palsy

2021 ◽  
Author(s):  
Teodor Stamate ◽  
Dan Cristian Moraru
Keyword(s):  
Brachial Plexus ◽  
Phrenic Nerve ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Distal Stump ◽  
Brachial Plexus Palsy ◽  
Nerve Transfers ◽  
Pectoral Nerve ◽  
Intercostal Nerves ◽  
Thoracodorsal Nerve

Nerve transfers (NT) consist in sectioning a donor nerve and connecting it to the distal stump of a recipient unrepairable nerve. For elbow flexion restoration in brachial plexus palsy (BPP) we used different NT: 1) GF motor Ulnar Nerve to Biceps nerve (Oberlin technique), 2) Double fascicular median/ulnar to biceps/brachialis nerve transfer (Mackinnon), 3) InterCostal Nerves (ICN) to MCN (+/− nerve graft), 4) Medial Pectoral Nerve (MPN) to MCN, 5) ThoracoDorsal Nerve (TDN) to MCN, 6) Spinal Accessory Nerve (SAN) to MCN transfer, 7) Phrenic Nerve (PhN) to MCN, 8) Cervical Plexus C3-C4 to MCN and 9) Contralateral C7 (CC7). I want to present my personal experience using the phrenic nerve (PhN), the intercostal nerves (ICN) and Oberlin’s technique. The aim of this retrospective study is to evaluate the results of this procedure in BPP. NT is an important goal in BPP. ICN transfer into the nerve of biceps for elbow flexion recovery is a reliable procedure in BPP. ICN transfer for triceps offers a positive alternative (Carroll transposition). Oberlin technique is simple and offers better results in a shorter amount of time and is an effective and safe option.

Results of Phrenic Nerve Transfer to the Musculocutaneous Nerve Using Video-Assisted Thoracoscopy in Patients with Traumatic Brachial Plexus Injury: Series of 28 Cases

2018 ◽  
Vol 17 (3) ◽  
pp. 261-267 ◽  
Author(s):  
Marcio de Mendonça Cardoso ◽  
Ricardo de Amoreira Gepp ◽  
Eduardo Mamare ◽  
José Fernando Guedes-Correa
Keyword(s):  
Pulmonary Function ◽  
Brachial Plexus ◽  
Phrenic Nerve ◽  
Operative Technique ◽  
Statistical Tests ◽  
Nerve Transfer ◽  
Forced Expiratory Volume ◽  
Musculocutaneous Nerve ◽  
Significance Level ◽  
Video Assisted

Abstract BACKGROUND The phrenic nerve can be transferred to the musculocutaneous nerve using video-assisted thoracoscopy, aiming at the recovery of elbow flexion in patients with traumatic brachial plexus injuries. There are few scientific papers in the literature that evaluate the results of this operative technique. OBJECTIVE To evaluate biceps strength and pulmonary function after the transfer of the phrenic nerve to the musculocutaneous nerve using video-assisted thoracoscopy. METHODS A retrospective study was carried out in a sample composed of 28 patients who were victims of traumatic injury to the brachial plexus from 2008 to 2013. Muscle strength was graded using the British Medical Research Council (BMRC) scale and pulmonary function through spirometry. Statistical tests, with significance level of 5%, were used. RESULTS In total, 74.1% of the patients had biceps strength greater than or equal to M3. All patients had a decrease in forced vital capacity and forced expiratory volume in 1 s, with no evidence of recovery over time. CONCLUSION Transferring the phrenic nerve to the musculocutaneous nerve using video-assisted thoracoscopy may lead to an increase in biceps strength to BMRC M3 or greater in most patients. Considering the deterioration in the parameters of spirometry observed in our patients and the future effects of aging in the respiratory system, it is not possible at the moment to guarantee the safety of this operative technique in the long term.

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