title: The phrenic nerve as a donor for brachial plexus injuries: is it safe and effective? Case series and literature analysis.
abstract: BACKGROUND
  Controversy exists surrounding the use of the phrenic nerve for transfer in severe brachial plexus injuries. The objectives of this study are: (1) to present the experience of the authors using the phrenic nerve in a single institution; and (2) to thoroughly review the existing literature to date.
  
  
  METHODS
  Adult patients with C5-D1 and C5-C8 lesions and a phrenic nerve transfer were retrospectively included. Patients with follow-up shorter than 18 months were excluded. The MRC muscle strength grading system was used to rate the outcome. Clinical repercussions relating to sectioning of the phrenic nerve were studied. An intense rehabilitation program was started after surgery, and compliance to this program was monitored using a previously described scale. Statistical analysis was performed with the obtained data.
  
  
  RESULTS
  Fifty-one patients were included. The mean time between trauma and surgery was 5.7 months. Three-quarters of the patients had C5-D1, with the remainder C5-C8. Mean post-operative follow-up was 32.5 months A MRC of M4 was achieved in 62.7% patients, M3 21.6%, M2 in 3.9%, and M1 in 11.8%. The only significant differences between the two groups were in graft length (9.8 vs. 15.1 cm, p = 0.01); and in the rehabilitation compliance score (2.86 vs. 2.00, p = 0.01).
  
  
  CONCLUSIONS
  Results of phrenic nerve transfer are predictable and good, especially if the grafts are short and the rehabilitation is adequate. It may adversely affect respiratory function tests, but this rarely correlates clinically. Contraindications to the use of the phrenic nerve exist and should be respected.
authors.affiliation: Nerve & Plexus Surgery Program, Division of Neurosurgery, University of Buenos Aires School of Medicine, Buenos Aires, Argentina, socolovsky@fibertel.com.ar.
authors.forename: Mariano
authors.initials: M
authors.lastname: Socolovsky
authors.forename: Gilda
authors.initials: G
authors.lastname: di Masi
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Bonilla
authors.forename: Miguel
authors.initials: M
authors.lastname: Domínguez Paez
authors.forename: Javier
authors.initials: J
authors.lastname: Robla
authors.forename: Camilo
authors.initials: C
authors.lastname: Calvache Cabrera
mesh_terms: D000293:Adolescent; D000328:Adult; D001917:Brachial Plexus / Q000293:injuries* / Q000601:surgery; D020516:Brachial Plexus Neuropathies / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016067:Nerve Transfer / Q000379:methods*; D010791:Phrenic Nerve / Q000637:transplantation*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult