THE FIRST CANADIAN EXPERIENCE OF INTERCOSTAL TO PHRENIC NERVE TRANSFERS FOR PHRENIC NERVE PALSY
Matthew WT Curran, MD, MSc1, Jenna-Lynn B Senger, MD, PhD2, Courtney Gail Wilkes, Medical Degree2, Julie C Beveridge, MD, MSc2, Ming Chan, MD3, Michael Morhart, MD, FRCSC4 and Jaret Olson, MD4, (1)Plastic and Reconstructive Surgery, University of Alberta, Edmonton, AB, Canada, (2)University of Alberta, Edmonton, AB, Canada, (3)Department of Plastic and Reconstructive Surgery, University of Alberta, Edmonton, AB, Canada, (4)Division of Plastic and Reconstructive Surgery, University of Alberta, Edmonton, AB, Canada
PURPOSE:
Phrenic nerve (PN) palsy can result in debilitating symptomatology and poor quality of life especially in active individuals. Prior surgical treatment of PN palsy was limited to diaphragmatic plication. Although there are small case series demonstrating successful neurotization of the PN using intercostal nerve donor in patients with high spinal cord injuries, outcomes in patients with idiopathic phrenic neuritis have not been reported. Therefore, this study's purpose is to present our initial experience in these patients following intercostal to PN transfer.
METHODS:
Two patients with hemidiaphragm paresis secondary to idiopathic phrenic neuritis were recruited. Intercostal nerves were dissected, and the distal end was coapted tension-free intra- or extra-thoracically to the PN. Pre- and post-operative outcome measures included diaphragmatic electromyography to assess nerve regeneration, pulmonary function tests (PFTs) and chest x-rays (CXR) to assess hemidiaphragm contractility. Functional disability was measured using three patient-reported outcomes: the London Chest Activity of Daily Living scale, St. George's Respiratory Questionnaire, and the SF-36.
RESULTS:
Age of the two patients with phrenic neuritis were (give numbers). Pre-operative EMG studies demonstrated complete PN denervation and no motor responses in both patients. Post-operative EMGs demonstrated reinnervation and motor recruitment in both patients. PFTs showed an increase in FEV1 post-operatively and CXR revealed complete resolution of hemidiaphragm elevation in one patient. Patient reported outcomes revealed a global improvement of quality of life and symptomatology. There were no complications.
CONCLUSIONS:
Phrenic neuritis is a rare condition with limited treatment options. This study demonstrates that intercostal to PN transfers may be a suitable surgical intervention in selected patients. Further studies on a larger sample of patients with different physical attributes and functional demands are required to fully assess the clinical utilities of this novel procedure.
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