Thoracoscopic harvesting of the phrenic nerve for treatment of brachial plexus avulsion injury: A preliminary report of clinical application

Objective To introduce the new surgical procedure of harvesting the phrenic nerve by thoracoscope. Methods The new procedure was applied in 5 patients with brachial plexus avulsion injury. The phrenic nerve was mobilized to its full length in the thorasic cavity and harvested thoracoscopically, and then transferred to the musculocutaneous nerve. The phrenic nerve was withdrawn out supraclavicularly in 3 cases and subclavicularly from the 2nd intercostal space in 2 cases. It was then coapted with the main trunk of the musculocutaneous nerve in 3 cases and with the motor branch of the musculocutaneous nerve in 2 cases. Results The first patient got the phrenic nerve regeneration evidence by EMG test 110 days after the operation. Conclusions Thoracoscopic harvesting of the phrenic nerve to its full length is the best way in phrenic nerve transfer with minor surgical trauma and faster recovery. Since the phrenic nerve is long enough to be transferred to the median nerve or the ulnar nerve, it might be a hopeful method to restore partial function of the lower trunk after brachial plexus whole root avulsion.