Comparative clinic study on vascularized and nonvascularized full-length phrenic nerve transfer

In order to understand whether the vascularizing procedure has any clinical value in nerve transfer and grafting, we compared nonvascularized and vascularized full-length phrenic never transfers in patients with a brachial plexus injury. Full-length phrenic nerve transfer to the musculocutaneous nerve had been conducted by the technique of video-assisted thoracic surgery in 15 patients. Three kinds of procedures were carried out. The first involved retaining the initial point of the phrenic nerve and dissecting the full-length distal nerve. The second involved keeping the cervical segment and isolating the thoracic segment of the phrenic nerve. The last involved vascularized phrenic nerve transfer. All these phrenic nerves were sutured to musculocutaneous nerves. After 28-35 months, the results of electrophysiology and function of the biceps brachii muscle were compared. All three procedures had no significant differences and led to the same functional recovery of the biceps brachii muscle after at least 28 months of follow-up. In conclusion, the vascularizing procedure had little clinical value, not only in full-length phrenic nerve transfer, but also in nerve grafting irrespective of the length of the gap, when the recipient bed had normal vascularity.