title: Phrenic nerve transfer in the restoration of elbow flexion in brachial plexus avulsion injuries: how effective and safe is it?
abstract: OBJECTIVE
  Phrenic nerve transfer has been used for treating lesions of the brachial plexus since 1970. Although, today, surgeons are more experienced with the technique, there are still widespread concerns about its effects on pulmonary function. This study was undertaken to evaluate the effectiveness and safety of this procedure.
  
  
  METHODS
  Fourteen patients with complete palsy of the upper limb were submitted to phrenic nerve transfer as part of a strategy for surgical reconstruction of their plexuses. Two patients were lost to follow-up, and 2 patients were followed for less than 2 years. Of the remaining 10 patients, 9 (90%) were male. The lesions affected both sides equally. The mean age of the patients was 24.8 years (range, 14-43 years), and the mean interval from injury to surgery was 6 months (range, 3-9 months). The phrenic nerve was always transferred to the musculocutaneous nerve, and a nerve graft (mean length, 8 cm; range, 4.5-12 cm) was necessary in all cases.
  
  
  RESULTS
  There was no major complication related to the surgery. Seven patients (70%) recovered functional level biceps strength (Medical Research Council grade >or=3). All of the patients exhibited a transient decrease in pulmonary function tests, but without clinical respiratory problems.
  
  
  CONCLUSIONS
  On the basis of our small series and data from the literature, we conclude that phrenic nerve transfer in well-selected patients is a safe and effective procedure for recovering biceps function.
authors.affiliation: Peripheral Nerve Surgery Unit, Department of Neurosurgery, São Paulo University Medical School, São Paulo, Brazil. mgsiqueira@uol.com.br
authors.forename: Mario G
authors.initials: MG
authors.lastname: Siqueira
authors.forename: Roberto S
authors.initials: RS
authors.lastname: Martins
mesh_terms: D000293:Adolescent; D000328:Adult; D001917:Brachial Plexus / Q000293:injuries* / Q000503:physiopathology / Q000601:surgery*; D020516:Brachial Plexus Neuropathies / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D004550:Elbow / Q000033:anatomy & histology / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D016067:Nerve Transfer / Q000379:methods*; D010243:Paralysis / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D010791:Phrenic Nerve / Q000033:anatomy & histology / Q000502:physiology / Q000637:transplantation*; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function / Q000502:physiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult