Brachial plexus neurotization with donor phrenic nerves and its effect on pulmonary function

Luedemann, Wolf; Hamm, Michael W.; Blömer, Ulrike; Samii, Madjid; Tatagiba, Marcos

doi:10.3171/jns.2002.96.3.0523

Cited by 78 publications

(40 citation statements)

References 20 publications

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“…Luedemann et al reported a series of 23 patients who underwent neurotization surgery with the phrenic nerve as the donor nerve and found that none of the 23 patients experienced pulmonary problems postoperatively; however, the patients incurred a higher risk of reduced pulmonary VC when using the right phrenic nerve than the left one. The authors suggested that if possible, the left phrenic nerve should be used [28]. Based on the above results and those of our previous report [11], we used the left phrenic nerve for transfer in all patients in the present study; none of them experienced pulmonary problems following the surgery.…”

Section: Discussionmentioning

confidence: 62%

Reinnervation of Bilateral Posterior Cricoarytenoid Muscles Using the Left Phrenic Nerve in Patients with Bilateral Vocal Fold Paralysis

Chen

Zheng

et al. 2013

PLoS ONE

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ObjectiveTo evaluate the feasibility, effectiveness, and safety of reinnervation of the bilateral posterior cricoarytenoid (PCA) muscles using the left phrenic nerve in patients with bilateral vocal fold paralysis.MethodsForty-four patients with bilateral vocal fold paralysis who underwent reinnervation of the bilateral PCA muscles using the left phrenic nerve were enrolled in this study. Videostroboscopy, perceptual evaluation, acoustic analysis, maximum phonation time, pulmonary function testing, and laryngeal electromyography were performed preoperatively and postoperatively. Patients were followed-up for at least 1 year after surgery.ResultsVideostroboscopy showed that within 1 year after reinnervation, abductive movement could be observed in the left vocal folds of 87% of patients and the right vocal folds of 72% of patients. Abductive excursion on the left side was significantly larger than that on the right side (P < 0.05); most of the vocal function parameters were improved postoperatively compared with the preoperative parameters, albeit without a significant difference (P > 0.05). No patients developed immediate dyspnea after surgery, and the pulmonary function parameters recovered to normal reference value levels within 1 year. Postoperative laryngeal electromyography confirmed successful reinnervation of the bilateral PCA muscles. Eighty-seven percent of patients in this series were decannulated and did not show obvious dyspnea after physical activity. Those who were decannulated after subsequent arytenoidectomy were not included in calculating the success rate of decannulation.ConclusionsReinnervation of the bilateral PCA muscles using the left phrenic nerve can restore inspiratory vocal fold abduction to a physiologically satisfactory extent while preserving phonatory function at the preoperative level without evident morbidity.

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Section: Discussionmentioning

confidence: 62%

Reinnervation of Bilateral Posterior Cricoarytenoid Muscles Using the Left Phrenic Nerve in Patients with Bilateral Vocal Fold Paralysis

Chen

Zheng

et al. 2013

PLoS ONE

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“…nerve (3,11,19,23,24). The best outcome of neurotization can be expected in short denervation times and in the presence of proximal healthy roots (4).…”

Section: Mohammad-reda A: Early Post-operative Results After Repair Omentioning

confidence: 99%

Early post operative results after repair of traumatic brachial plexus palsy

Ahmad

2012

Turkish Neurosurgery

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AIm: Treatment options for traumatic brachial plexus injuries include nerve grafting, or neurotization. The type of lesion and the reconstructive procedures affect functional results and postoperative pain relief. mAterIAl and methOds: A total number of twenty five patients suffering from post-traumatic brachial plexus injury were included in the study. The patients underwent exploration and primary repair of the affected plexus, based on case by case policy.results: Spinal accessory nerve transfer to suprascapular nerve procedure regained 78.95% of functional muscle power, 10.50% of non functional muscle power and only 10.5 % of non innervated muscle. The Oberlin procedure regained 83.33% with elbow flexion muscle power, 16.67% with non functional muscle power. Intercostal nerve transfer to musculocutaneous nerve regained 62.5% with functional muscle power, 25% with non functional muscle power and only 12.5 % with non innervated muscle. The shoulder, elbow and wrist extension functions were significantly improved early post-operatively. In addition, the post-operative improvement of shoulder, elbow and wrist extension functions had significant negative correlations with the pre-operative elapsed time, and accompanied by a significant positive correlation with post-operative follow up period.COnClusIOn: Early intervention for traumatic brachial plexus palsy is recommended to get good results with pain relief. BulGulAr: Supraskapular sinire spinal aksesuar sinir transferi %78,95 işlevsel kas gücü, %10,50 işlevsel olmayan kas gücü ve sadece %10,5 innerve olmayan kas kazandırdı. Oberlin işlemi %83,33 dirsek fleksiyonu kas gücü ve %16,67 işlevsel olmayan kas gücü kazandırdı. Müskülokütanöz sinire interkostal sinir transferi %62,5 işlevsel kas gücü, %25 işlevsel olmayan kas gücü ve sadece%12,55 innerve olmayan kas kazandırdı. Omuz, dirsek ve bilek ekstansiyon işlevleri postoperatif erken dönemde önemli ölçüde düzeldi. Ayrıca, omuz, dirsek ve bilek ekstansiyon işlevlerinin postoperatif düzelmesinin preoperatif geçen süreyle önemli bir negatif korelasyonu bulundu ve postoperatif takip dönemiyle önemli bir pozitif korelasyonu vardı. sOnuÇ: Travmatik brakiyal pleksus palsisinde ağrı giderilmesiyle birlikte iyi sonuçlar alınması için erken girişim önerilir.

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“…The second drawback to the use of the phrenic nerve is that its harvest usually results in decline of pulmonary function, 34 at least temporarily; and more significantly affecting the right hemithorax. 35 This is a problem chiefly in infants susceptible to recurrent upper respiratory tract infections and in adults with impaired cardiac or pulmonary function. Most authors do not recommend the use of the phrenic nerve in these patients.…”

Section: Donor Nervesmentioning

confidence: 99%