Full length phrenic nerve transfer for restoration of finger flexion: a clinical report

Abstract

Objective To evaluate the effect of VATS full length phrenic nerve transfer to medial head of the median nerve for finger flexion restoration in brachial plexus total avulsion injuries. Methods Three patients with brachial plexus total avulsions were treated. The phrenic nerve was mobilized to its full length in the thoracic cavity and harvested thoracoscopically. It was then transferred to the medial head of the median nerve. Postoperatively the patients were followed every 3 months for evaluation of pulmonary function and clinical examination. Results All 3 patients were followed for over 3 years. Muscle power of flexor pollicis longus and flexor digitorum superficialis was 3° to 4°. Palmaris longus strength was 2° in 2 cases and 1° in 1 case. There was no recovery of flexor carpi radialis, pronator teres and thenar muscle. Pulmonary function was reduced within the first 6 months after the surgery but returned to preoperative level after 1 year. Conclusion Thoracoscopic harvesting of phrenic nerve and transfer full length phrenic nerve to the medial head of the median nerve is a safe and useful choice to restore finger flexion in brachial plexus injury patients. Key words: Thoracoscopy; Phrenic nerve; Brachial plexus; Medial head of median nerve