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J Hand Microsurg
DOI: 10.1055/s-0043-1764162
Original Article

Functional Outcome following Phrenic Nerve Transfer in Brachial Plexus Injury

Amit Kumar Vyas 
1   Hand and Microsurgery Orthopedic Specialty Services, Durgapura, Jaipur, Rajasthan, India; Fortis Escorts Hospital, Jaipur, Rajasthan, India
,
Aviral Gupta
2   Department of Hand and Microsurgery, Rukhmani Birla Hospital, Jaipur, Rajasthan, India
,
Bharat Dhanjani
3   Department of Orthopedic Surgery, Rungta Hospital, Jaipur, Rajasthan, India
,
Santosh Batajoo
4   Department of Orthopedic Surgery, Hand and Microsurgery Specialty Services, Jaipur, Rajasthan
,
Sayantani Misra 
5   Department of Pediatric Orthopedic Surgery, National Centre for Child Health and Development (NCCHD), Tokyo, Japan
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Abstract

Background Brachial plexus injuries are debilitating injuries resulting in paralyzed shoulder to global paralysis of the upper extremity. Treatment strategies have evolved over the years with nerve transfer forming the mainstay of surgical management. Phrenic nerve provides certain advantages as donor over other options but has been less preferred due to fear of pulmonary complications. In this study, we assess the functional outcomes of phrenic nerve transfer in brachial plexus injuries.

Materials and Methods A retrospective study was performed on 18 patients operated between 2012 and 2017. The mean duration of injury to surgery was 4.56 months and mean follow-up was for 3.66 years. Phrenic nerve was used as donor to neurotize either biceps and brachialis branch of musculocutaneous nerve or suprascapular nerve. Assessment was done through Waikakul score for elbow flexion and Medical Research Council grading for shoulder abduction. Respiratory function assessment was done through questionnaire.

Results Twelve (80%) patients recovered grade 3 and above elbow flexion with 6 patients having a positive endurance test according to Waikakul and a “very good” result. In phrenic to suprascapular transfer group (3 patients), all patients had more than grade 3 recovery of shoulder abduction. No patient complained of respiratory problems.

Conclusion Phrenic nerve can be used as a reliable donor with suitable patient selection with good results in regaining muscle power without any anticipated effects on respiratory function.

Keywords

phrenic nerve transfer - brachial plexus injury - nerve transfer - Waikakul score

Informed Consent

There is no information (name, initial, hospital identification numbers, or photographs) in the submitted manuscript that can be used to identify patients.




Publication History

Article published online:
31 March 2023

© 2023. Society of Indian Hand Surgery & Microsurgeons. All rights reserved.

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