Journal article
Phrenic Nerve Reconstruction for Effective Surgical Treatment of Diaphragmatic Paralysis
Annals of plastic surgery, v 87(3), pp 310-315
01 Sep 2021
PMID: 34397519
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Diaphragmatic paralysis due to phrenic nerve injury may cause orthopnea, exertional dyspnea, and sleep-disordered breathing. Phrenic nerve reconstruction may relieve symptoms and improve respiratory function. A retrospective review of 400 consecutive patients undergoing phrenic nerve reconstruction for diaphragmatic paralysis at 2 tertiary treatment centers was performed between 2007 and 2019. Symptomatic patients were identified, and the diagnosis was confirmed on radiographic evaluations. Assessment parameters included pulmonary spirometry (forced expiratory volume in 1 second and FVC), maximal inspiratory pressure, compound muscle action potentials, diaphragm thickness, chest fluoroscopy, and Short Form 36 Health Survey Questionnaire (SF-36) survey. There were 81 females and 319 males with an average age of 54 years (range, 19-79 years). The mean duration from diagnosis to surgery was 29months (range, 1-320 months). The most common etiologies were acute or chronic injury (29%), interscalene nerve block (17%), and cardiothoracic surgery (15%). The mean improvements in forced expiratory volume in 1 second and FVC at 1 year were 10% (P < 0.01) and 8% (P < 0.05), respectively. At 2-year follow-up, the corresponding values were 22% (P < 0.05) and 18% (P < 0.05), respectively. Improvement on chest fluoroscopy was demonstrated in 63% and 71% of patients at 1 and 2-year follow-up, respectively. There was a 20%(P < 0.01) improvement in maximal inspiratory pressure, and compound muscle action potentials increased by 82% (P < 0.001). Diaphragm thickness demonstrated a 27% (P < 0.01) increase, and SF-36 revealed a 59% (P < 0.001) improvement in physical functioning. Symptomatic diaphragmatic paralysis should be considered for surgical treatment. Phrenic nerve reconstruction can achieve symptomatic relief and improve respiratory function. Increasing spirometry and improvements on Sniff from 1 to 2 years support incremental recovery with longer follow-up.
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Details
- Title
- Phrenic Nerve Reconstruction for Effective Surgical Treatment of Diaphragmatic Paralysis
- Creators
- Matthew R. Kaufman - Institute for Advanced ReconstructionEric I. Chang - Institute for Advanced ReconstructionThomas Bauer - Jersey Shore University Medical CenterKristie Rossi - Institute for Advanced ReconstructionAndrew I. Elkwood - Institute for Advanced ReconstructionEthan Paulin - Jersey Shore University Medical CenterReza Jarrahy - Ronald Reagan UCLA Medical Center
- Publication Details
- Annals of plastic surgery, v 87(3), pp 310-315
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 6
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Surgery
- Web of Science ID
- WOS:000686756800016
- Scopus ID
- 2-s2.0-85113636183
- Other Identifier
- 991021930434904721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Surgery