The phrenic nerve as a donor for brachial plexus injuries: is it safe and effective? Case series and literature analysis
| Autor: | Miguel Domínguez Paez, Mariano Socolovsky, Gonzalo Bonilla, Camilo Calvache Cabrera, Gilda Di Masi, Javier Robla |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Young Adult medicine Humans Brachial Plexus Single institution Brachial Plexus Neuropathies Nerve Transfer Brachial Plexus Neuropathy Retrospective Studies Phrenic nerve medicine.diagnostic_test business.industry musculoskeletal neural and ocular physiology Interventional radiology Middle Aged musculoskeletal system medicine.disease Surgery Phrenic Nerve Treatment Outcome nervous system Brachial plexus injury Anesthesia Female Neurology (clinical) Neurosurgery business Brachial plexus circulatory and respiratory physiology |
| Zdroj: | Acta Neurochirurgica. 157:1077-1086 |
| ISSN: | 0942-0940 0001-6268 |
| DOI: | 10.1007/s00701-015-2387-7 |
| Popis: | Controversy exists surrounding the use of the phrenic nerve for transfer in severe brachial plexus injuries. The objectives of this study are: (1) to present the experience of the authors using the phrenic nerve in a single institution; and (2) to thoroughly review the existing literature to date.Adult patients with C5-D1 and C5-C8 lesions and a phrenic nerve transfer were retrospectively included. Patients with follow-up shorter than 18 months were excluded. The MRC muscle strength grading system was used to rate the outcome. Clinical repercussions relating to sectioning of the phrenic nerve were studied. An intense rehabilitation program was started after surgery, and compliance to this program was monitored using a previously described scale. Statistical analysis was performed with the obtained data.Fifty-one patients were included. The mean time between trauma and surgery was 5.7 months. Three-quarters of the patients had C5-D1, with the remainder C5-C8. Mean post-operative follow-up was 32.5 months A MRC of M4 was achieved in 62.7% patients, M3 21.6%, M2 in 3.9%, and M1 in 11.8%. The only significant differences between the two groups were in graft length (9.8 vs. 15.1 cm, p = 0.01); and in the rehabilitation compliance score (2.86 vs. 2.00, p = 0.01).Results of phrenic nerve transfer are predictable and good, especially if the grafts are short and the rehabilitation is adequate. It may adversely affect respiratory function tests, but this rarely correlates clinically. Contraindications to the use of the phrenic nerve exist and should be respected. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full text from SpringerLink