Pulmonary and biceps function after intercostal and phrenic nerve transfer for brachial plexus injuries

Area of Science:

• Neurosurgery
• Thoracic Surgery
• Reconstructive Surgery

Background:

• Brachial plexus injuries, particularly those involving nerve root avulsions, often necessitate nerve transfer procedures.
• Restoring both upper extremity function and respiratory capacity is crucial for patient outcomes.

Purpose of the Study:

• To compare the efficacy of intercostal versus phrenic nerve transfer to the musculocutaneous nerve for treating brachial plexus injuries.
• To evaluate the impact of these nerve transfers on pulmonary function and biceps motor recovery.

Main Methods:

• A pseudo-randomized study involving 36 patients with brachial plexus injuries and nerve root avulsions.
• Patients underwent either intercostal (19) or phrenic (17) nerve transfer.
• Pulmonary function (Forced Vital Capacity, FEV1, VC, Tidal Volume) and biceps motor recovery were assessed pre- and post-operatively.

Main Results:

• Pulmonary function significantly improved within 3 months following intercostal nerve transfer, returning to normal levels.
• Phrenic nerve transfer resulted in significantly reduced pulmonary function persisting up to 1 year post-surgery.
• Biceps motor recovery was notably faster in the intercostal nerve transfer group compared to the phrenic nerve transfer group.

Conclusions:

• Intercostal nerve transfer demonstrates superior short-term outcomes for both pulmonary function and biceps motor recovery in brachial plexus injury patients.
• Phrenic nerve transfer may have a more prolonged negative impact on pulmonary function.