Reinnervation of the Paralyzed Diaphragm: Application of Nerve Surgery Techniques Following Unilateral Phrenic Nerve Injury

Kaufman, Matthew R.; Elkwood, Andrew I.; Rose, Michael I.; Patel, Tushar R.; Ashinoff, Russell L.; Saad, Adam; Caccavale, Robert J.; Bocage, Jean; Cole, Jeffrey A.; Soriano, Aida; Fein, Edward

doi:10.1378/chest.1107881

Cited by 13 publications

(25 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The paralyzed diaphragm improvement following plication is in the order of 20‐40%. These improvements were shown to last over time …”

Section: Discussionmentioning

confidence: 90%

“…These improvements were shown to last over time. [41][42][43][44] Because of the wide variation of symptoms of PNP and the time needed to recovery, the issue of when to proceed to surgical plication remains controversial. While some surgeons prefer to perform plication immediately upon diagnosis, others recommend waiting up to few weeks on stable patients since spontaneous recovery may occur in over 50% of the cases.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Management of phrenic nerve palsy following cardiac surgery

El-Masri

Saj

Wehbe³

et al. 2018

J Card Surg

View full text Add to dashboard Cite

show abstract

“…The paralyzed diaphragm improvement following plication is in the order of 20‐40%. These improvements were shown to last over time …”

Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Management of phrenic nerve palsy following cardiac surgery

El-Masri

Saj

Wehbe³

et al. 2018

J Card Surg

View full text Add to dashboard Cite

show abstract

“…11,12 Although plication of the diaphragm has been the surgical treatment option most familiar to clinicians, scattered case reports and a vast experience performing phrenic nerve reconstruction at our centers over the last 10 years has demonstrated it to be an effective alternative. [13][14][15][16] Phrenic nerve reconstruction is specifically aimed at restoring diaphragmatic functional activity, something plication surgery does not achieve. Nerve reconstruction generally requires longer follow-up periods than static procedures due to the gradual neuromuscular recovery that occurs in accordance with the sequential processes of peripheral nerve regeneration and muscle strengthening.…”

mentioning

confidence: 99%

Long-Term Follow-Up after Phrenic Nerve Reconstruction for Diaphragmatic Paralysis: A Review of 180 Patients

Kaufman

Elkwood

Brown

et al. 2016

J reconstr Microsurg

Self Cite

View full text Add to dashboard Cite

Phrenic nerve reconstruction has been evaluated as a method of restoring functional activity and may be an effective alternative to diaphragm plication. Longer follow-up and a larger cohort for analysis are necessary to confirm the efficacy of this procedure for diaphragmatic paralysis. A total of 180 patients treated with phrenic nerve reconstruction for chronic diaphragmatic paralysis were followed for a median 2.7 years. Assessment parameters included: 36-Item Short Form Health Survey (SF-36) physical functioning survey, spirometry, chest fluoroscopy, electrodiagnostic evaluation, a five-item questionnaire to assess specific functional issues, and overall patient-reported outcome. Overall, 134 males and 46 females with an average age of 56 years (range: 10-79 years) were treated. Mean baseline percent predicted values for forced expiratory volume in 1 second, forced vital capacity, vital capacity, and total lung capacity, were 61, 63, 67, and 75%, respectively. The corresponding percent improvements in percent predicted values were: 11, 6, 9, and 13% ( ≤ 0.01; ≤ 0.01; ≤ 0.05; ≤ 0.01). Mean preoperative SF-36 physical functioning survey scores were 39%, and an improvement to 65% was demonstrated following surgery ( ≤ 0.0001). Nerve conduction latency, improved by an average 23% ( ≤ 0.005), and there was a corresponding 125% increase in diaphragm motor amplitude ( ≤ 0.0001). A total of 89% of patients reported an overall improvement in breathing function. Long-term assessment of phrenic nerve reconstruction for diaphragmatic paralysis indicates functional correction and symptomatic relief.

show abstract

“…prompt microsurgical reconstruction might be the optimal treatment for diaphragmatic dysfunction caused by tumor infiltration of the phrenic nerve once curative resection of the tumor has been performed . Follow‐up of patients on which this type of procedure has been carried out have demonstrated optimal results . To the best of our knowledge, there have been no reports in the literature which have focused on the technique we performed here, even though some teams have proposed other approaches such as neurotization of the phrenic nerve with the trapezius branch of the ipsilateral spinal accessory nerve, or reconstruction of the phrenic nerve employing fibers of sural nerve .…”

Section: Discussionmentioning

confidence: 99%

Importance of muldisciplinary management of giant mediastinal sarcoma: A case report with phrenic nerve reconstruction

et al. 2020

View full text Add to dashboard Cite

Primary synovial sarcoma is a soft tissue tumor which originates from synoviallike undeveloped mesenchymal structures. Here, we report the case of a giant mediastinal sarcoma in a 41-year-old female patient. After diagnosis, she underwent neoadjuvant chemotherapy. Due to its low efficacy, we collegially decided to undergo cytoreductive debulking surgery. The mass invaded the phrenic nerve bilaterally and its excision caused a severe lesion of the left nerve and a partial impairment of the right one. Thus, plastic surgeons decided to reconstruct the right phrenic nerve employing the contralateral remaining fibers. The invasiveness of this tumor, its difficult removal, histological profile and the peculiar technique to preserve diaphragmatic function classify this case as very rare. The therapeutic strategy was based on interdisciplinary teamwork which comprised several specialists' opinions. Our strategy allowed us to pursue the challenging objective to give a young woman with a severe diagnosis the best possible chance of achieving a good quality of life. To the best of our knowledge, this phrenic nerve reconstructive technique is very rare and has not previously been reported in the literature. The report emphasizes that it is possible to deal with an apparently impossible case through a collaborative approach involving several different medical specialist professionals.

show abstract

Reinnervation of the Paralyzed Diaphragm: Application of Nerve Surgery Techniques Following Unilateral Phrenic Nerve Injury

Cited by 13 publications

References 0 publications

Management of phrenic nerve palsy following cardiac surgery

Management of phrenic nerve palsy following cardiac surgery

Long-Term Follow-Up after Phrenic Nerve Reconstruction for Diaphragmatic Paralysis: A Review of 180 Patients

Importance of muldisciplinary management of giant mediastinal sarcoma: A case report with phrenic nerve reconstruction

Contact Info

Product

Resources

About