Results of Phrenic Nerve Transfer to the Musculocutaneous Nerve Using Video-Assisted Thoracoscopy in Patients with Traumatic Brachial Plexus Injury: Series of 28 Cases

• Published in: Operative neurosurgery (Hagerstown, Md.) Vol. 17; no. 3; pp. 261 - 267
• Main Authors: Cardoso, Marcio de Mendonça, Gepp, Ricardo de Amoreira, Mamare, Eduardo, Guedes-Correa, José Fernando
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 01-09-2019; Wolters Kluwer Health, Inc
• Subjects: Brachial plexus; Instrumentation industry; Joint and ligament injuries; Lung volume measurement; Methods; Neurophysiology; Neurosurgery; Spirometry; Thoracoscopy; Time; Brazil; Nerve transfer; Phrenic nerve; Brachial plexus; thoracoscopic surgeries; Musculocutaneous nerve; Trauma
• ISSN: 2332-4252; 2332-4260
• DOI: 10.1093/ons/opy350

Abstract
BACKGROUND
The phrenic nerve can be transferred to the musculocutaneous nerve using video-assisted thoracoscopy, aiming at the recovery of elbow flexion in patients with traumatic brachial plexus injuries. There are few scientific papers in the literature that evaluate the results of this operative technique.
OBJECTIVE
To evaluate biceps strength and pulmonary function after the transfer of the phrenic nerve to the musculocutaneous nerve using video-assisted thoracoscopy.
METHODS
A retrospective study was carried out in a sample composed of 28 patients who were victims of traumatic injury to the brachial plexus from 2008 to 2013. Muscle strength was graded using the British Medical Research Council (BMRC) scale and pulmonary function through spirometry. Statistical tests, with significance level of 5%, were used.
RESULTS
In total, 74.1% of the patients had biceps strength greater than or equal to M3. All patients had a decrease in forced vital capacity and forced expiratory volume in 1 s, with no evidence of recovery over time.
CONCLUSION
Transferring the phrenic nerve to the musculocutaneous nerve using video-assisted thoracoscopy may lead to an increase in biceps strength to BMRC M3 or greater in most patients. Considering the deterioration in the parameters of spirometry observed in our patients and the future effects of aging in the respiratory system, it is not possible at the moment to guarantee the safety of this operative technique in the long term.