J reconstr Microsurg 2017; 33(01): 063-069
DOI: 10.1055/s-0036-1588018
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Long-Term Follow-Up after Phrenic Nerve Reconstruction for Diaphragmatic Paralysis: A Review of 180 Patients

Matthew R. Kaufman
1  Center for Treatment of Paralysis and Reconstructive Nerve Surgery, Jersey Shore University Medical Center, Neptune, New Jersey
2  Division of Plastic and Reconstructive Surgery, David Geffen UCLA Medical Center, Los Angeles, California
,
Andrew I. Elkwood
1  Center for Treatment of Paralysis and Reconstructive Nerve Surgery, Jersey Shore University Medical Center, Neptune, New Jersey
,
David Brown
3  Department of Physical Medicine and Rehabilitation, JFK Medical Center, Edison, New Jersey
,
John Cece
1  Center for Treatment of Paralysis and Reconstructive Nerve Surgery, Jersey Shore University Medical Center, Neptune, New Jersey
,
Catarina Martins
1  Center for Treatment of Paralysis and Reconstructive Nerve Surgery, Jersey Shore University Medical Center, Neptune, New Jersey
,
Thomas Bauer
4  Division of Thoracic Surgery, Jersey Shore University Medical Center, Neptune, New Jersey
,
Jason Weissler
5  Department of Surgery, Robert Wood Johnson University Medical Center, New Brunswick, New Jersey
,
Kameron Rezzadeh
2  Division of Plastic and Reconstructive Surgery, David Geffen UCLA Medical Center, Los Angeles, California
,
Reza Jarrahy
2  Division of Plastic and Reconstructive Surgery, David Geffen UCLA Medical Center, Los Angeles, California
› Author Affiliations
Further Information

Publication History

03 June 2016

15 July 2016

Publication Date:
25 September 2016 (eFirst)

Abstract

Background Phrenic nerve reconstruction has been evaluated as a method of restoring functional activity and may be an effective alternative to diaphragm plication. Longer follow-up and a larger cohort for analysis are necessary to confirm the efficacy of this procedure for diaphragmatic paralysis.

Methods A total of 180 patients treated with phrenic nerve reconstruction for chronic diaphragmatic paralysis were followed for a median 2.7 years. Assessment parameters included: 36-Item Short Form Health Survey (SF-36) physical functioning survey, spirometry, chest fluoroscopy, electrodiagnostic evaluation, a five-item questionnaire to assess specific functional issues, and overall patient-reported outcome.

Results Overall, 134 males and 46 females with an average age of 56 years (range: 10–79 years) were treated. Mean baseline percent predicted values for forced expiratory volume in 1 second, forced vital capacity, vital capacity, and total lung capacity, were 61, 63, 67, and 75%, respectively. The corresponding percent improvements in percent predicted values were: 11, 6, 9, and 13% (p ≤ 0.01; ≤ 0.01; ≤ 0.05; ≤ 0.01). Mean preoperative SF-36 physical functioning survey scores were 39%, and an improvement to 65% was demonstrated following surgery (p ≤ 0.0001). Nerve conduction latency, improved by an average 23% (p ≤ 0.005), and there was a corresponding 125% increase in diaphragm motor amplitude (p ≤ 0.0001). A total of 89% of patients reported an overall improvement in breathing function.

Conclusion Long-term assessment of phrenic nerve reconstruction for diaphragmatic paralysis indicates functional correction and symptomatic relief.