The phrenic nerve transfer in the treatment of a septuagenarian with brachial plexus avulsion injury: a case report
Jie Lao, M.D., Huashan Hospital, Shanghai, China
Introduction：Phrenic nerve transfer has been a well-established procedure for restoring elbow flexion function in patients with brachial plexus avulsion injury (BPAI). Concerning about probably detrimental respiratory effects brought by the operation, however, stirred up quite a bit of controversy. In the present case, we transferred phrenic nerve to musculocutaneous nerve bridged by superficial branch of radial nerve graft for reconstruction of elbow flexion in a 70-year-old female patient with BPAI.
Methods：Preoperative chest x-ray, pulmonary function test and electrocardiography were also conducted, the outcomes of which excluded any pulmonary or cardiac disease and permitted the subsequent surgical strategy.The brachial plexus was explored in scalene space by a resection of platysma and partial sternocleidomastoid muscle. The dissection of brachial plexus roots was abandoned due to dense tough scar tissue envelope and serious adhesion. Intraoperative EMG confirmed the diagnosis of preganglionic injury, which indicated the surgical strategy of nerve transfer. The musculocutaneous nerve originated from lateral cord was dissected and proximally transected. The phrenic nerve was isolated at the lateral edge of anterior scalene muscle and normal function of it was confirmed by electrical stimulation eliciting potent diaphragm contraction. We divided and transected the phrenic nerve as distally as possible. The proximal end of the phrenic nerve was coapted via a 15 cm-long superficial branch of radial nerve graft to the distal end of musculocutaneous nerve using 8/0 Prolene sutures.
Results：Active contractions of the biceps brachii muscle were perceived at the 18-month follow-up visit. In the latest follow-up, 5.5 years after the phrenic nerve transfer operation, elbow flexion scored M3+ and became independent without facilitatory respiration. In the EMG study, the biceps brachii muscle and infraspinatus muscle showed successful electromyographic reinnervation with compound muscle action potential (CMAP) reaching mono-mix phase and monophase, respectively.
Conclusions： This case has the successful application of phrenic nerve as donor to reinnervate the biceps in a septuagenarian with brachial plexus avulsion injury, not accompanied with significant clinical respiratory problem.
Back to 2021 ePosters