Long-Term Outcome of Phrenic Nerve Transfer in Brachial Plexus Avulsion Injuries

Introduction: In brachial plexus injuries, useful recovery of arm function has been documented in most patients alter phrenic nerve transfer after variable follow-up durations. but there is not much information about long-term functional outcomes. In addition, there is still some concern that respiratory complications might become manifest with aging. The aim of this study was to report the outcome of phrenic nerve transfer after a minimum follow-up of 5 years. Patients and Methods: Twenty-six patients were reviewed and evaluated clinically. Age at surgery averaged 25.2 years and follow-up averaged 9.15 years. Results: Shoulder abduction and external rotation achieved by transfer of phrenic to axillary nerve (or posterior division of upper trunk), combined with spinal accessory to suprascapular nerve transfer, were better than that achieved by transfer of phrenic to suprascapular nerve, combined with grafting the posterior division of upper trunk from C5, 52.3 and 45.5 degrees versus 47.5 and 39.4 degrees, respectively. There was no difference in abduction when the phrenic nerve was transferred directly to the posterior division of upper trunk or to the axillary nerve using nerve graft. Elbow flexion (>= M3 MRC) was achieved in 5 (83.3%) of 6 cases. Elbow extension M4 MRC or greater was achieved in 4 (66.6%) of 6 cases. All patients, including those who exceeded the age of 45 years and those who had concomitant intercostal nerve transfer, continued to have no respiratory symptoms. Conclusions: The long-term follow-up confirms the safety and effectiveness and of phrenic nerve transfer for functional restoration of shoulder and elbow functions in brachial plexus avulsion injuries.

Automated summary

This study reports on the long-term outcomes of phrenic nerve transfer for functional restoration of shoulder and elbow functions in brachial plexus avulsion injuries. The results showed that patients achieved better shoulder abduction and external rotation with the transfer of phrenic to axillary nerve, with no respiratory complications observed even in older patients.