gms | German Medical Science

Objectives/Interrogation: N. phrenicus is a classic extra-plexus donor of axons for re-innervation of the muscles innervated by n. musculocutaneus, n. suprascapularis, n. medianus, n. ulnaris, n. radialis, n. axillaris by performing end-to-end or end-to-side microsurgical anastomoses with nerve-grafts (n. suralis, n. saphenus). A new method of direct neurotisation of n.axillaris with n. phrenicus was presented as n. phrenicus is taken endoscopically in its full length immediately before it sank into the diaphragm. M1 contractions (MRC) of m. deltoideus was reported 2 months postoperatively. A major factor for successful neurotisation is time, most importantly, the donor/recipient nerve distance.

Methods: 4 adult patients with brachial plexus trauma are presented. Our approach to those with C5, C6, C7 avulsion and C8, Th1 neuropraxia was: 3 months after the trauma first stage of surgery treatment is presented - modified Oberlin method for restoration of elbow function is performed, as well as other nerve transfer was also carried out at the same stage: n. accessorius to n. suprascapularis. In the second stage neurotisation of n. axillaris is performed by taking full length of n. phrenicus endoscopically before it sank into the diaphragmatic musculature.

Results and Conclusions: M1 (MRC) muscle contractions of m. deltoideus are reported on the 2nd postoperative month. The length of the intrathoracic n.phrenicus is 22 cm. This shortens the reinnervation time with 7-12 months. For the period of March-September 2018 we have operated 4 patients with this methodology. The use of n. phrenicus as a donor nerve in the case of end-to-end coaptation does not lead to permanent impairment of respiratory capacity and pulmonary function of the patient. This is a revolutionary method of restoration of affected muscles after plexus brachialis trauma. A major factor in their successful neurotisation is the time. i.e., the donor/recipient nerve distance. The use of n.phrenicus with its full length as a donor shortens the re-innervation time of the impaired muscles. This is particularly important in patients who have not had pre-operative nerve stimulation of the denervated muscles or delayed treatment.