Although the efficacy of end-to-side neurorrhaphy was reported lower than for end-to-end neurorrhaphy, the phrenic nerve could still provide motor recovery for elbow flexion even with an end-to-side neurorrhaphy.4 The phrenic nerve is composed mainly of myelinated motor nerve fibers and discharges spontaneous impulses that could be stimulated by deep breathing.5 These features might contribute to its superior regeneration capacity. Electrophysiologic studies suggested diaphragm elevation or excursion limitation. The suturing procedure or the winding technique might be the reason for abnormality of the phrenic nerve in the nerve conduction study. However, function of the diaphragm could be preserved. In conclusion, phrenic nerve transfer with end-to-side neurorrhaphy is capable of providing functional biceps recovery in a majority of patients, with preservation of diaphragm function (Table 1).
Mou-Xiong Zheng, M.D.
Department of Hand Surgery, Hua-Shan Hospital, Fudan University, and, Shanghai Key Laboratory of Peripheral Nerve Microsurgery
Wen-Dong Xu, M.D., Ph.D.
Department of Hand Surgery, Hua-Shan Hospital, Fudan University, Shanghai Key Laboratory of Peripheral Nerve Microsurgery, and, State Key Laboratory of Medical Neurobiology, Fudan University
Yun-Dong Shen, M.D., Ph.D.
Jian-Guang Xu, M.D., Ph.D.
Yu-Dong Gu, M.D.
Department of Hand Surgery, Hua-Shan Hospital, Fudan University, and, Shanghai Key Laboratory of Peripheral Nerve Microsurgery, Shanghai, People's Republic of China
This work was supported by Chinese National Basic Research Program grant no. 2003CB515300; “Dawn” Program of Shanghai Education Commission, China, grant no. 06SG04; and Program for New Century Excellent Talents in University, China, grant no. NCET-07-0209.
The authors have no conflicts of interest to disclose.
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3. Chalidapong P, Sananpanich K, Kraisarin J, Bumroongkit C. Pulmonary and biceps function after intercostal and phrenic nerve transfer for brachial plexus injuries. J Hand Surg Br. 2004;29:8–11.
4. Wang M, Xu W, Zheng M, Teng F, Xu J, Gu Y. Phrenic nerve end-to-side neurotization in treating brachial plexus avulsion: An experimental study in rats. Ann Plast Surg. 2011;66:370–376.
5. Nail BS, Sterling GM, Widdicombe JG. Patterns of spontaneous and reflexly-induced activity in phrenic and intercostal motoneurons. Exp Brain Res. 1972;15:318–332.
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