Long-term Follow-up Of Respiratory Function After Phrenic Nerve And Intercostal Nerves Transfer For Avulsed Brachial Plexus Injury

Background:Brachial plexus avulsion injury (BPAI) is one of the most serious trauma of upper extremity, and the treatment of BPAI has been a difficult for surgeons. Up to now, nerve transfer is the main way for treating BPAI. There have been more than 10 nerve transfer methods since 1970s. Among them, phrenic nerve transfer (PNT) and multiple intercostal nerves transfer (MIT) are both commonly-used methods in treating brachial plexus avulsion injuries (BPAI). As both of the transferred nerves are respiratory nerves, the respiratory effect of PNT and/or MIT has remained a major concern for surgeons.Objective:To investigate long term pulmonary and diaphragmatic function after phrenic nerve combined with intercostal nerve transfer in adults with brachial plexus avulsed injury. To determine the safe combination strategy of these two transfers.Methods:From 1990 to 2002, a total of 42 patients underwent phrenic nerve transfer (PIT) and/or multiple intercostal nerves transfer (MIT) in Hand Surgery Department of Huashan Hospital were enrolled in the study. 23 adults with brachial plexus avulsed injuries (BPAI) underwent phrenic nerve combined multiple intercostal nerves transfer (PN-MIT) were compared with 19 corresponding adults who underwent phrenic nerve transfer (PNT) only. Pulmonary function testing, electromyologram study, chest fluoroscopy were performed to assess pulmonary and diaphragmatic function. In the PNT-MIT group, further comparison was performed to investigate whether total number of transferred intercostal nerves and the timing of MIT influence the results.Results:In PNT-MIT group FVC, FEV,, TLC were 73.69%, 72.04% and 74.81% of predicted without significant differences from PNT group. Diaphragmatic paralysis still existed with 0.5-1 intercostal spaces (ICS) reduced excursion of hemidiaphragm without statistically difference between PNT and PNT-MIT groups. Furthermore, in the PNT-MIT group, 2-4 intercostal nerves transfer resulted in no further decrease in pulmonary function. No significant difference was found when MIT was performed at one stage or after 1-2 months delay.Conclusion:In long term observation, PNT-MIT doesn't result in significant impairment on respiratory function in BPAI patients.