Intercostal nerve transfer for restoration of the diaphragm muscle function after phrenic nerve transfer in total brachial plexus avulsion.

ABSTRACT

OBJECT To determine the possibility of innervation of the diaphragm muscle using intercostal nerve after ipsilateral phrenic nerve transfer in total brachial plexus avulsion. METHODS: Bilateral phrenic nerves and the 9th intercostal nerves were observed inside the thorax. The point where the phrenic nerve entered the diaphragm muscle (point A), the point where the 9th intercostal nerve gave rise to the cutaneous branch (point B) and crossed the posterior axillary line (point C) and the point where the posterior axillary line met the insertion of the diaphragm muscle (point D) were identified. The distances between points B and C, points A and C and from points A through D to C were recorded respectively. The 9th intercostal nerve was transferred to the distal stump of the phrenic nerve in one patient after phrenic nerve transfer to avulsed brachial plexus. RESULTS: The mean distances between points B and C, points A and C and from points A through D to C were 12.20 ± 1.04 cm, 10.32 ± 1.02 cm and 16.43 ± 0.91 cm on the right side respectively, 11.78 ± 1.21 cm, 7.77 ± 0.85 cm and 11.74 ± 1.00 cm on the left side respectively. The 9th intercostal nerve was used to innervate the distal stump of the phrenic nerve in one patient after the phrenic nerve transfer to the avulsed brachial plexus. The diaphragm muscle function partially recovered one year after the operation. CONCLUSION: The 9th intercostal nerve can be transferred to the distal stump of the phrenic nerve to restore the diaphragm muscle function according to the anatomical study. The movement of the diaphragm muscle was partially restored in one clinical case.