Video-assisted thoracoscopic surgery (VATS) aided full-length phrenic nerve transfer for restoration of elbow flexion

Author:

Gunasagaran Jayaletchumi1ORCID,Ab Wahab Nuraliza1,Khoo Saw Sian1ORCID,Shamsul Shams Amir1,Shivdas Sachin1ORCID,Hashim Shahrul2,Ahmad Tunku Sara1

Affiliation:

1. National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

2. Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

Abstract

Background In complete brachial plexus injury, phrenic nerve (PN) is frequently used in neurotization for elbow flexion restoration. The advancement in video-assisted thoracoscopic surgery (VATS) allows full-length PN dissection intrathoracically for direct coaptation to recipient without nerve graft. Purpose We report our experience in improving the surgical technique and its outcome. Methods Seven patients underwent PN dissection via VATS and full-length transfer to musculocutaneous nerve (MCN) or motor branch of biceps (MBB) from June 2015 to June 2018. Comparisons were made with similar group of patients who underwent conventional PN transfer. Results Mean age of patients was 21.9 years. All were males involved in motorcycle accidents who sustained complete brachial plexus injury. We found the elbow flexion recovery were earlier in full-length PN transfer. However, there was no statistically significant difference in elbow flexion strength at 3 years post-surgery. Conclusion We propose full-length PN transfer for restoration of elbow flexion in patients with delayed presentation.

Publisher

SAGE Publications

Subject

Surgery

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