Use of the phrenic nerve for brachial plexus reconstruction

To examine the clinical effectiveness and safety of phrenic nerve neurotization for brachial plexus reconstruction, the authors retrospectively analyzed the surgically treated cases within the period between August 1970 and March 1990. There was a total of 180 patients who sustained brachial plexus injuries and had phrenic nerve transfer. The phrenic nerve was identified and traced distally to give the longest possible length and sectioned. The proximal stump was coapted to the distal segment of the musculocutaneous nerve, either directly or through a nerve graft. Sixty-five patients who were seen in followup for >2 years were studied. The time taken for the return of a muscle power rating of 3 (M3) in the biceps muscle ranged from 3 to 30 months; the average time was 9.5 months. Of the patients, 84.6% regained biceps power to M3 and greater strength. Only 1 patient had a transient respiratory problem after surgery. Pulmonary function tests showed decreased pulmonary capacities within 1 year of operation, improving toward 2 years. Thus, it is concluded that phrenic nerve neurotization can be accepted as a sound option for the restoration of biceps function in brachial plexus injury.