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A5868 - Effects of Phrenic Nerve Transfer for Traumatic Brachial Plexus Injury on Respiratory Function - A Single Centre Experience
Author Block: M. Casey1, C. O'Donnell2, R. Dolan3, K. Cronin3, S. P. Gaine4; 1Department of Medicine, Mater Misericordiae Hospital, Dublin, Ireland, 2Department of Medicine, Mater Misericordiae Hospital, Co. Dublin, Ireland, 3Department of Surgery, Mater Misericordiae Hospital, Dublin, Ireland, 4Department of Medicine, Mater Misericordiae Hosp, Dublin 7, Ireland.
Introduction: Traumatic brachial plexus injuries may require nerve transfer to the affected arm muscle. A variety of nerves may be used for this kind of procedure, including the phrenic nerve. Phrenic nerve transfer (PNT) has been demonstrated to be effective, leading to useful recovery of arm function in certain patients.(1) However a significant concern following PNT is potential impairment of lung function due to a loss of diaphragmatic innervation post-procedure. We describe a single centre experience with the procedure. Methods: We carried out a retrospective case series in a single centre, at the Mater Misericordiae University Hospital, Dublin, Ireland. A total of 24 consecutive patients who underwent phrenic nerve transfers for traumatic avulsion injuries between 2005-2015 with a minimum 1 year follow up were included. Functional respiratory status was assessed using subjective measures including London Chest Activity of Daily Living (LCADL) Questionnaire and objective pulmonary function testing (PFTs). Results: 24 patients (22 male) were included in the study, with a median age of 30.5 years. Mean follow up was 61.9 months. The mechanism of injury was post-road traffic accident (RTA) for 21 patients, 2 were post-fall and 1 patient had a penetrating wound. 13 patients had a left phrenic nerve transfer and 11 patients had a right phrenic nerve transfer. Of the 24 patients who underwent PNT, 13 completed both PFTS and LCADL questionnaires. 6 of 13 (46%) patients had normal spirometry. 5 (38%) had a restrictive deficit while 2 (15%) had an obstructive or mixed deficit. Of the 5 patients with a restrictive deficit, 4 were of moderate severity and 1 was severe based on ATS guidelines. 3 of 13 (23%) patients were symptomatic based on the quality of life questionnaire, all of whom had abnormal lung function on testing. A further 7 patients completed the LCADL questionnaire only, all of whom were asymptomatic. This results in a total of 17 out of 20 (85%) patients who were asymptomatic based on respiratory symptoms following the procedure. All the symptomatic patients had a left phrenic nerve transfer Conclusion: This study demonstrates that the PNT procedure is a safe method for re-innervation in traumatic brachial plexus injury. We have demonstrated that this surgery has some impact on measurable lung function without a significant impact on post-operative symptoms.