title: Reinnervation of the paralyzed diaphragm: application of nerve surgery techniques following unilateral phrenic nerve injury.
abstract: BACKGROUND
  Unilateral phrenic nerve injury often results in symptomatic hemidiaphragm paralysis, and currently few treatment options exist. Reported etiologies include cardiac surgery, neck surgery, chiropractic manipulation, and interscalene nerve blocks. Although diaphragmatic plication has been an option for treatment, the ideal treatment would be restoration of function to the paralyzed hemidiaphragm. The application of peripheral nerve surgery techniques for phrenic nerve injuries has not been adequately evaluated.
  
  
  METHODS
  Twelve patients presenting with long-term, symptomatic, unilateral phrenic nerve injuries following surgery, chiropractic manipulation, trauma, or anesthetic blocks underwent a comprehensive evaluation, including radiographic and electrophysiologic assessments. Surgical treatment was offered following a minimum of 6 months of conservative management. Operative planning was based on preoperative and intraoperative testing using one or more established nerve reconstruction techniques (neurolysis, interpositional grafting, or neurotization).
  
  
  RESULTS
  Measures of postoperative improvement included pulmonary function testing, fluoroscopic sniff testing, and a standardized quality-of-life survey, from which it was determined that eight of nine patients who could be completely evaluated experienced improvements in diaphragmatic function.
  
  
  CONCLUSIONS
  Based on the favorable results in this small series, we suggest expanding nerve reconstruction techniques to phrenic nerve injury treatment and propose an algorithm for treatment of unilateral phrenic nerve injury that may expand the current limitations in therapy.
authors.affiliation: Department of Surgery, Institute for Advanced Reconstruction, Shrewsbury, NJ; Department of Surgery, Drexel College of Medicine, Philadelphia, PA. Electronic address: kaufmanmatthew@hotmail.com.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Kaufman
authors.affiliation: Department of Surgery, Institute for Advanced Reconstruction, Shrewsbury, NJ.
authors.forename: Andrew I
authors.initials: AI
authors.lastname: Elkwood
authors.affiliation: Department of Surgery, Institute for Advanced Reconstruction, Shrewsbury, NJ.
authors.forename: Michael I
authors.initials: MI
authors.lastname: Rose
authors.affiliation: Department of Surgery, Institute for Advanced Reconstruction, Shrewsbury, NJ.
authors.forename: Tushar
authors.initials: T
authors.lastname: Patel
authors.affiliation: Department of Surgery, Institute for Advanced Reconstruction, Shrewsbury, NJ.
authors.forename: Russell
authors.initials: R
authors.lastname: Ashinoff
authors.affiliation: Department of Surgery, Drexel College of Medicine, Philadelphia, PA.
authors.forename: Adam
authors.initials: A
authors.lastname: Saad
authors.affiliation: Thoracic Group, Somerset, NJ.
authors.forename: Robert
authors.initials: R
authors.lastname: Caccavale
authors.affiliation: Thoracic Group, Somerset, NJ.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Bocage
authors.affiliation: Kessler Institute for Rehabilitation, West Orange, NJ.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Cole
authors.affiliation: Somerset Pulmonary/Critical Care Asthma and Sleep Center, Somerset, NJ.
authors.forename: Aida
authors.initials: A
authors.lastname: Soriano
authors.affiliation: Robert Wood Johnson University Hospital, New Brunswick, NJ.
authors.forename: Ed
authors.initials: E
authors.lastname: Fein
mesh_terms: D000328:Adult; D000368:Aged; D003964:Diaphragm / Q000294:innervation* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D010791:Phrenic Nerve / Q000293:injuries* / Q000601:surgery; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D012129:Respiratory Function Tests; D015656:Respiratory Mechanics / Q000502:physiology*; D012133:Respiratory Paralysis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome