A Comparative Clinical Study of Vascularized and Non-Vascularized Full-Length Phrenic Nerve Transfers

In order to determine if vascularization procedures have any clinical significance in nerve transfer and grafting, the authors compared non-vascularized to vascularized full-length phrenic never transfers in patients with brachial plexus injury.

Full-length phrenic nerve transfers to musculocutaneous nerves were conducted using the technique of video-assisted thoracic surgery in 15 patients. Three kinds of procedures were carried out. The first was retaining the initial point of the phrenic nerve and dissecting the full-length distal nerve. The second was keeping the cervical segment and isolating the thoracic segment of the phrenic nerve. The last was vascularized phrenic nerve transfer. All the phrenic nerves were sutured to the musculocutaneous nerves. After 28 to 35 months, the results of electrophysiologic evaluation and function of the biceps brachii muscle were compared.

There was no statistically significant difference between the procedures, and there was the same functional recovery of the biceps brachii muscle to M3 after about 6 months.

The vascularization procedure had little clinical significance, not only in full-length phrenic nerve transfer, but also in nerve grafting regardless of the length of the gap, when the recipient bed had normal vascularity.