Phrenic nerve transfer in brachial plexus injury

3 The procedure

3.1 The procedure is performed with the patient under general anaesthesia, by a supraclavicular approach. The brachial plexus is explored and the root avulsion confirmed. The phrenic nerve is identified in the neck on the surface of the scalenus anterior muscle, or in the chest thorascopically to provide a longer segment for grafting. Phrenic nerve function is confirmed by neurophysiology. The nerve is divided, transferred and joined to the distal segment of the selected damaged nerve either directly or via an interposition graft if necessary. The aim of the procedure is to re-innervate the target muscles and improve arm function.

3.2 Postoperatively, a head and shoulder spica may be applied for several weeks to avoid tension on the nerve transfer. Specialist rehabilitation is provided to maximise the recovery of useful arm function.

3.3 Phrenic nerve transfer may be combined with other donor nerve transfers at the same time or in stages.