PDF herunterladen
CC BY 4.0 · J Brachial Plex Peripher Nerve Inj 2021; 16(01): e1-e9
DOI: 10.1055/s-0041-1722979
Original Contribution

Pearls and Pitfalls of Phrenic Nerve Transfer for Shoulder Reconstruction in Brachial Plexus Injury

Kazuteru Doi
1   Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi City, Yamaguchi Prefecture, Japan
,
Sei Haw Sem
1   Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi City, Yamaguchi Prefecture, Japan
2   Department of Orthopaedics, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
,
Bipin Ghanghurde
1   Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi City, Yamaguchi Prefecture, Japan
3   Hand surgery, Kusum Orthopedic Centre, Mumbai, Maharashtra, India
4   Hand surgery, Wadia Hospital, Mumbai, Maharashtra, India
5   Hand surgery, Surya Hospital, Mumbai, Maharashtra, India
,
Yasunori Hattori
1   Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi City, Yamaguchi Prefecture, Japan
,
Sotetsu Sakamoto
1   Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi City, Yamaguchi Prefecture, Japan
› Institutsangaben
› Weitere Informationen
   Lizenzen und Reprints

Abstract

Objectives The purpose of this study was to report the functional outcomes of phrenic nerve transfer (PNT) to suprascapular nerve (SSN) for shoulder reconstruction in brachial plexus injury (BPI) patients with total and C5–8 palsies, and its pulmonary complications.

Methods Forty-four out of 127 BPI patients with total and C5–8 palsies who underwent PNT to SSN for shoulder reconstruction were evaluated for functional outcomes in comparison with other types of nerve transfers. Their pulmonary function was analyzed using vital capacity in the percentage of predicted value and Hugh-Jones (HJ) breathless classification. The predisposing factors to develop pulmonary complications in those patients were examined as well.

Results PNT to SSN provided a better shoulder range of motion significantly as compared with nerve transfer from C5 root and contralateral C7. The results between PNT and spinal accessory nerve transfer to SSN were comparable in all directions of shoulder motions. There were no significant respiratory symptoms in majority of the patients including six patients who were classified into grade 2 HJ breathlessness grading. Two predisposing factors for poorer pulmonary performance were identified, which were age and body mass index, with cut-off values of younger than 32 years old and less than 23, respectively.

Conclusions PNT to SSN can be a reliable reconstructive procedure in restoration of shoulder function in BPI patients with total or C5–8 palsy. The postoperative pulmonary complications can be prevented with vigilant patient selection.

Keywords

brachial plexus injury - phrenic nerve transfer - suprascapular nerve


Publikationsverlauf

Eingereicht: 11. Juni 2020

Angenommen: 12. Oktober 2020

Artikel online veröffentlicht:
10. Februar 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Spinner RJ, Shin AY, Elhassan BT, Bishop A. Traumatic brachial plexus injury. In: Green DP, Hotchkiss RN, Pederson WC, Wolfe SW. eds. Green's Operative Hand Surgery, 7th ed. New York, NY: Churchill Livingstone; 2017: 1146-1207
    Google Scholar
  • 2 Doi K, Hattori Y, Sakamoto S, Dodakundi C, Satbhai NG, Montales T. Current procedure of double free muscle transfer for traumatic total brachial plexus palsy. JBJS Essential Surg Tech 2013; 3: e16
    PubMedGoogle Scholar
  • 3 Hentz VR, Doi K. Traumatic brachial plexus injury. In: Green DP, Hotchkiss RN, Pederson WC, Wolfe SW. eds. Green's Operative Hand Surgery, 5th ed. New York, NY: Churchill Livingstone; 2005: 1319-1371
    Google Scholar
  • 4 NICE (National Institute for Health and Care Excellence). Phrenic nerve transfer in brachial plexus injury. Interventional procedure guidance. . Published November 27, 2013. Accessed October 26, 2020 at: nice.org.uk/guidance/ipg468
    PubMedGoogle Scholar
  • 5 Socolovsky M, di Masi G, Bonilla G, Domínguez Paez M, Robla J, Calvache Cabrera C. The phrenic nerve as a donor for brachial plexus injuries: is it safe and effective? Case series and literature analysis. Acta Neurochir (Wien) 2015; 157 (06) 1077-1086 , discussion 1086
    CrossrefPubMedGoogle Scholar
  • 6 Chuang DC, Lee GW, Hashem F, Wei FC. Restoration of shoulder abduction by nerve transfer in avulsed brachial plexus injury: evaluation of 99 patients with various nerve transfers. Plast Reconstr Surg 1995; 96 (01) 122-128
    CrossrefPubMedGoogle Scholar
  • 7 Gu Y-D, Ma M-K. Use of the phrenic nerve for brachial plexus reconstruction. Clin Orthop Relat Res 1996; (323) 119-121
    PubMedGoogle Scholar
  • 8 Liu Y, Lao J, Zhao X. Comparative study of phrenic and intercostal nerve transfers for elbow flexion after global brachial plexus injury. Injury 2015; 46 (04) 671-675
    CrossrefPubMedGoogle Scholar
  • 9 Sungpet A, Suphachatwong C, Kawinwonggowith V. Restoration of shoulder abduction in brachial plexus injury with phrenic nerve transfer. Aust N Z J Surg 2000; 70 (11) 783-785
    CrossrefPubMedGoogle Scholar
  • 10 Bertelli JA, Ghizoni MF. C5-8 brachial plexus root injury: the “T-1 hand”. J Neurosurg 2012; 116 (02) 409-413
    CrossrefPubMedGoogle Scholar
  • 11 Satbhai NG, Doi K, Hattori Y, Sakamoto S. Functional outcome and quality of life after traumatic total brachial plexus injury treated by nerve transfer or single/double free muscle transfers: a comparative study. Bone Joint J 2016; 98-B (02) 209-217
    CrossrefPubMedGoogle Scholar
  • 12 Dodakundi C, Doi K, Hattori Y. et al. Outcome of surgical reconstruction after traumatic total brachial plexus palsy. J Bone Joint Surg Am 2013; 95 (16) 1505-1512
    CrossrefPubMedGoogle Scholar
  • 13 Pornrattanamaneewong C, Limthongthang R, Vathana T, Kaewpornsawan K, Songcharoen P, Wongtrakul S. Diaphragmatic height index: new diagnostic test for phrenic nerve dysfunction. J Neurosurg 2012; 117 (05) 890-896
    CrossrefPubMedGoogle Scholar
  • 14 McCool FD, Tzelepis GE. Dysfunction of the diaphragm. N Engl J Med 2012; 366 (10) 932-942
    CrossrefPubMedGoogle Scholar
  • 15 Hugh-Jones P, Lambert AV. A simple standard exercise test and its use for measuring exertion dyspnoea. BMJ 1952; 1 (4749): 65-71
    CrossrefPubMedGoogle Scholar
  • 16 Songcharoen P. Management of brachial plexus injury in adults. Scand J Surg 2008; 97 (04) 317-323
    CrossrefPubMedGoogle Scholar
  • 17 Garg R, Merrell GA, Hillstrom HJ, Wolfe SW. Comparison of nerve transfers and nerve grafting for traumatic upper plexus palsy: a systematic review and analysis. J Bone Joint Surg Am 2011; 93 (09) 819-829
    CrossrefPubMedGoogle Scholar
  • 18 Suzuki K, Doi K, Hattori Y, Pagsaligan JM. Long-term results of spinal accessory nerve transfer to the suprascapular nerve in upper-type paralysis of brachial plexus injury. J Reconstr Microsurg 2007; 23 (06) 295-299
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 19 Chuang ML, Chuang DC, Lin IF, Vintch JR, Ker JJ, Tsao TC. Ventilation and exercise performance after phrenic nerve and multiple intercostal nerve transfers for avulsed brachial plexus injury. Chest 2005; 128 (05) 3434-3439
    CrossrefPubMedGoogle Scholar
  • 20 Xu WD, Gu YD, Lu JB, Yu C, Zhang CG, Xu JG. Pulmonary function after complete unilateral phrenic nerve transection. J Neurosurg 2005; 103 (03) 464-467
    CrossrefPubMedGoogle Scholar
  • 21 Zheng MX, Qiu YQ, Xu WD, Xu JG. Long-term observation of respiratory function after unilateral phrenic nerve and multiple intercostal nerve transfer for avulsed brachial plexus injury. Neurosurgery 2012; 70 (04) 796-801 , discussion 801
    CrossrefPubMedGoogle Scholar
  • 22 Luedemann W, Hamm M, Blömer U, Samii M, Tatagiba M. Brachial plexus neurotization with donor phrenic nerves and its effect on pulmonary function. J Neurosurg 2002; 96 (03) 523-526
    CrossrefPubMedGoogle Scholar
  • 23 Zheng MX, Qiu YQ, Xu WD, Xu JG. Long-term observation of respiratory function after unilateral phrenic nerve and multiple intercostal nerve transfer for avulsed brachial plexus injury. Neurosurgery 2012; 70: 796-801
    CrossrefPubMedGoogle Scholar
  • 24 Siqueira MG, Martins RS. Phrenic nerve transfer in the restoration of elbow flexion in brachial plexus avulsion injuries: how effective and safe is it?. Neurosurgery 2009; 65 (4, Suppl): A125-A131
    CrossrefPubMedGoogle Scholar
  • 25 Wang S, Sun X, Hsia TC, Lin X, Li M. The effects of body mass index on spirometry tests among adults in Xi'an, China. Medicine (Baltimore) 2017; 96 (15) e6596
    CrossrefPubMedGoogle Scholar
  • 26 Groth SS, Andrade RS. Diaphragmatic eventration. Thorac Surg Clin 2009; 19 (04) 511-519
    CrossrefPubMedGoogle Scholar