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

Area of Science:

• Neurosurgery
• Pulmonary Medicine
• Orthopedic Surgery

Background:

• Brachial plexus injuries and root avulsions often require reconstructive surgery.
• Neurotization procedures utilize donor nerves to restore function.
• The phrenic nerve is a potential donor nerve for neurotization, but its impact on pulmonary function is not fully understood.

Purpose of the Study:

• To evaluate the pulmonary side effects of neurotization procedures using the phrenic nerve.
• To compare pulmonary function before and after surgery in patients with brachial plexus injury.

Main Methods:

• Twenty-three patients with complete brachial plexus palsy underwent neurotization using the phrenic nerve.
• Pulmonary function tests, including vital capacity and maximal inspiratory pressure, were performed pre- and postoperatively.
• Body plethysmography was conducted more than 12 months after surgery in 12 patients.

Main Results:

• No immediate postoperative pulmonary complications were observed.
• A significant reduction in vital capacity (9.8%) was noted across all patients.
• Right-sided phrenic nerve transfers resulted in a significant vital capacity reduction (14.3%), while left-sided transfers showed a nonsignificant reduction (3.6%).

Conclusions:

• Using the right phrenic nerve for neurotization increases the risk of reduced pulmonary vital capacity.
• Preference should be given to the left phrenic nerve when possible.
• Preoperative measurement of maximal inspiratory pressure is recommended to identify patients at risk for further pulmonary decline.