USE OF THE PHRENIC-NERVE FOR BRACHIAL-PLEXUS RECONSTRUCTION

To examine the clinical effectiveness and safety of phrenic nerve neur otization for brachial plexus reconstruction, the authors retrospectiv ely analyzed the surgically treated cases within the period between Au gust 1970 and March 1990. There was a total of 180 patients who sustai ned brachial plexus injuries and had phrenic nerve transfer. The phren ic nerve was identified and traced distally to give the longest possib le length and sectioned. The proximal stump was coapted to the distal segment of the musculocutaneous nerve, either directly or through a ne rve 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 o f 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 M 3 and greater strength. Only 1 patient had a transient respiratory pro blem after surgery. Pulmonary function tests showed decreased pulmonar y capacities within 1 year of operation, improving toward 2 years. Thu s, it is concluded that phrenic nerve neurotization can be accepted as a sound option for the restoration of biceps function in brachial ple xus injury.