Clinical application and efficacy of phrenic nerve transferring to the anterior division of upper trunk of brachial plexus for treatment of the brachial plexus injury

Objective:To analyze the causes of less approved results for patients with phrenic nerve transfer to upper trunk of brachial plexus, and to suggest some preventive measures for getting a better clinical outcome. Methods:Retrospective analysis was carried out in 38 patients who had been operated with phrenic nerve transfer to upper trunk of brachial plexus from Mar.1999 to Feb.2005. Six cases of these patients were performed reoperations because their discouraged results. The recovery state of musculocutaneous nerve was followed up and its function was evaluated according to the probation criterions established by the hand surgery institute of Chinese Medical Association. Results:29 patients had been followed up over 15 months. There were 18 cases belonged to the good clinical result group and 11 cases poor one. Comparing with two groups, the course of diseases and the rate of traction injury were statistically different(P0.05). Through surgical exploration, some possible causes leading to poor clinical result were found: high tension at nerve commissure, multiple level brachial plexus injuries and the anatomical variation of brachial plexus. A modified measure to relieve the tension at nerve commissure was attempted in some cases and it was proved to be effective. Conclusions:Many factors may influence the outcome of phrenic nerve transfer to upper trunk of brachial plexus which can be abolished by the careful selection of operative indications and proper application of the modified measure.