The phrenic nerve as a donor for brachial plexus injuries: is it safe and effective? Case series and literature analysis

Malessy

Lopez

et al. 2017

FOC

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OBJECTIVE Neuroplasticity is analyzed in this article as the capacity of the CNS to adapt to external and internal stimuli. It is being increasingly recognized as an important factor for the successful outcome of nerve transfers. Better-known factors are the number of axons that cross the coaptation site, the time interval between trauma and repair, and age. Neuroplasticity is mediated initially by synaptic and neurotransmitter changes. Over time, the activation of previously existing but lowly active connections in the brain cortex contributes further. Dendritic sprouting and axonal elongation might also take place but are less likely to be prominent. METHODS The authors reviewed different factors that play roles in neuroplasticity and functional regeneration after specific nerve transfers. RESULTS The authors found that these different factors include, among others, the distance between cortical areas of the donor and receptor neurons, the presence versus absence of preexisting lowly active interneuronal connections, gross versus fine movement restoration, rehabilitation, brain trauma, and age. CONCLUSIONS The potential for plasticity should be taken into consideration by surgeons when planning surgical strategy and postoperative rehabilitation, because its influence on results cannot be denied.

Section: Intercostal or Phrenic Nerve Transfer To The Musculocutaneoumentioning

confidence: 67%

Current concepts in plasticity and nerve transfers: relationship between surgical techniques and outcomes

Malessy

Lopez

et al. 2017

FOC

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“…Specific objectives of our study were as follows: (1) to identify any difference between patients under age 20, 20 to 29, and 30 yr old or older in 3 outcomes: (a) elbow flexion strength measured using the British MRC (Medical Research Council) Scale; (b) active shoulder abduction, measured in degrees; and (c) overall outcome as a binary variable (a good outcome vs a poor to fair outcome); (2) to identify any correlation between age and the 2 outcomes elbow flexion strength and shoulder range of movement (ROM); (3) to identify any other age threshold besides age 20 (distinguishing between children/adolescents and adults) that might distinguish between patients likely to have a good vs poor to fair outcome; and (4) to identify other nonsurgical predictors of a good vs poor to fair outcome.…”

mentioning

confidence: 99%

Age as a Predictor of Long-Term Results in Patients with Brachial Plexus Palsies Undergoing Surgical Repair

Masi

Bonilla

et al. 2017

ONSURG

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“…The existence of accessory phrenic nerves might explain this phenomenon. 8,11,17,18 Contraindications to using the phrenic nerve as a donor in brachial plexus surgery usually include preoperative impairment of diaphragmatic or pulmonary function (as a consequence of the trauma itself); severe traumatic lesions of the thoracic wall-as multiple rib fractures 15 ; and patient age younger than 3 years. [19][20][21][22] It is important to emphasize that we observed such limitations very carefully when selecting our cases for the procedures described herein, which might explain why no patient in our series complained of respiratory distress following surgery.…”

Section: Discussion Phrenic Nerve As Donor In Brachial Plexus Surgerymentioning

confidence: 99%

“…Epidemiological, surgical, and postoperative data from 10 patients who underwent brachial plexus surgery in 9 of 12 patients. Socolovsky et al18 observed good outcomes from 60 to 83.5% of their patients by targeting different nerves, especially the musculocutaneous nerve.…”

mentioning

confidence: 99%

Phrenic Nerve Transfer for Reconstruction of Elbow Extension in Severe Brachial Plexus Injuries

Flores¹,

2016

J reconstr Microsurg

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Background Restoring elbow extension is an important objective to pursue when repairing the brachial plexus in patients with a flail arm. Based upon the good results obtained using the phrenic nerve to restore elbow flexion and shoulder stability, we hypothesized that this nerve could also be employed to reconstruct elbow extension in patients with severe brachial plexus injuries. Methods A retrospective study of 10 patients in which the phrenic nerve targeted the radial nerve (7 patients) or the branch to the long head of the triceps (3 patients) as a surgical strategy for reconstruction of the brachial plexus. Results The mean postoperative follow-up time was 34 months. At final follow-up, elbow extension graded as M4 was measured in three patients, Medical Research Council MRC M3 in five patients, and M2 in one patient, while one patient experienced no measurable recovery (M0). No patient complained or demonstrated any signs of respiratory insufficiency postoperatively. Conclusions The phrenic nerve is a reliable donor for reanimation of elbow extension in such cases, and the branch to the long head of the triceps should be considered as a better target for the nerve transfer.