Journal article
Reinnervation of the Paralyzed Diaphragm Application of Nerve Surgery Techniques Following Unilateral Phrenic Nerve Injury
Chest, v 140(1), pp 191-197
01 Jul 2011
PMID: 21349932
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Background: Unilateral phrenic nerve injury often results in symptomatic hemidiaphragm paralysis, and currently few treatment options exist. Reported etiologies include cardiac surgery, neck surgery, chiropractic manipulation, and interscalene nerve blocks. Although diaphragmatic plication has been an option for treatment, the ideal treatment would be restoration of function to the paralyzed hemidiaphragm. The application of peripheral nerve surgery techniques for phrenic nerve injuries has not been adequately evaluated.
Methods: Twelve patients presenting with long-term, symptomatic, unilateral phrenic nerve injuries following surgery, chiropractic manipulation, trauma, or anesthetic blocks underwent a comprehensive evaluation, including radiographic and electrophysiologic assessments. Surgical treatment was offered following a minimum of 6 months of conservative management. Operative planning was based on preoperative and intraoperative testing using one or more established nerve reconstruction techniques (neurolysis, interpositional grafting, or neurotization).
Results: Measures of postoperative improvement included pulmonary function testing, fluoroscopic sniff testing, and a standardized quality-of-life survey, from which it was determined that eight of nine patients who could be completely evaluated experienced improvements in diaphragmatic function.
Conclusions: Based on the favorable results in this small series, we suggest expanding nerve reconstruction techniques to phrenic nerve injury treatment and propose an algorithm for treatment of unilateral phrenic nerve injury that may expand the current limitations in therapy. CHEST 2011; 140(1):191-197
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Details
- Title
- Reinnervation of the Paralyzed Diaphragm Application of Nerve Surgery Techniques Following Unilateral Phrenic Nerve Injury
- Creators
- Matthew R. Kaufman - Drexel UniversityAndrew I. Elkwood - Institute for Advanced ReconstructionMichael I. Rose - Institute for Advanced ReconstructionTushar Patel - Institute for Advanced ReconstructionRussell Ashinoff - Institute for Advanced ReconstructionAdam Saad - Drexel UniversityRobert Caccavale - Thoracic Group, Somerset, NJJean-Philippe Bocage - Thoracic Group, Somerset, NJJeffrey Cole - Kessler Institute for RehabilitationAida Soriano - Somerset Pulmonary/Critical Care Asthma and Sleep Center, Somerset, NJEd Fein - Robert Wood Johnson University Hospital
- Publication Details
- Chest, v 140(1), pp 191-197
- Publisher
- Amer Coll Chest Physicians
- Number of pages
- 7
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Surgery
- Web of Science ID
- WOS:000292796700032
- Scopus ID
- 2-s2.0-79960408012
- Other Identifier
- 991019169502204721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Critical Care Medicine
- Respiratory System