title: Impact of phrenic nerve paralysis on the surgical outcome of intercostal nerve transfer.
abstract: Brachial plexus injuries (BPI) can be complicated by diaphragmatic paralysis (DP). This study determined the influence of DP on biceps brachii (BB) recovery after intercostal nerve transfer (ICNT) for BPI and investigated the respiratory complications of ICNT. The study included 100 patients, 84 showing no DP in preoperative and early postoperative chest radiographic images (non-DP group) and 16 with DP that persisted for over one year after surgery (DP group). The postoperative reinnervation time did not differ between groups. BB strength one year after surgery was lower in the DP group than non-DP group (p = 0.0007). No differences were observed 2-3 years after surgery. In the DP group, four patients had respiratory symptoms that affected daily activities and their outcomes deteriorated (p = 0.04). Phrenic nerve transfer should not be combined with ICNT in patients with poor respiratory function because of the high incidence of respiratory complications.
authors.affiliation: Department of Orthopedic Surgery, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Kita
authors.forename: Yasuhito
authors.initials: Y
authors.lastname: Tajiri
authors.forename: Shinya
authors.initials: S
authors.lastname: Hoshikawa
authors.forename: Yukinori
authors.initials: Y
authors.lastname: Hara
authors.forename: Junichi
authors.initials: J
authors.lastname: Iijima
mesh_terms: D000293:Adolescent; D000328:Adult; D020516:Brachial Plexus Neuropathies / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007367:Intercostal Nerves / Q000637:transplantation*; D008297:Male; D016067:Nerve Transfer / Q000379:methods*; D010791:Phrenic Nerve / Q000503:physiopathology; D011859:Radiography; D012133:Respiratory Paralysis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Brachial Plexus Injury; Diaphragmatic Paralysis; Intercostal Nerve Transfer; Phrenic Nerve Transfer