1.1 The limited quantity of evidence on the efficacy of phrenic nerve transfer in brachial plexus injury shows useful recovery of arm function in some patients, but there is very little information about long-term functional and quality-of-life outcomes, and evidence on safety shows some impairment of respiratory function. However, patients with brachial plexus injuries are often very disabled and treatment options may be limited. Therefore, this procedure may be used with normal arrangements for clinical governance, consent and audit.
1.2 During the consent process patients should be informed, in particular, that the procedure may not restore useful function in the arm and that it may compromise respiratory function.
1.3 Patient selection and treatment should only be carried out in units that specialise in the management of complex brachial plexus injuries and offer a full range of treatment options.