Korean J Thorac Cardiovasc Surg.  2002 Oct;35(10):730-735.

Change of Diaphragmatic Level and Movement Following Division of Phrenic Nerve

Affiliations
  • 1Department of Thoracic and Cardiovascular Surgery, Wonkwang University School of Medicine, Iksan, Jeonbuk, Korea. jobchoi@wonkwang.ac.kr
  • 2Department of Orthopedic Surgery, Wonkwang University School of Medicine, Iksan, Jeonbuk, Korea.

Abstract

BACKGROUND: Diaphragm is innervated by phrenic nerve and lower intercostal nerves. For patients with avulsion injury of brachial plexus, an in situ graft of phrenic nerve is frequently used to neurotize a branch of the brachial plexus. We studied short-term and mid-term changes of diaphragmatic level and movement in patients with dissection of phrenic nerve for neurotization. MATERIAL AND METHOD: Thirteen patients with division of either-side phrenic nerve for neurotization of musculocutaneous nerve were included in this study. With endoscopic surgical procedure, the intrathoracic phrenic nerve was entirely dissected and divided just above the diaphragm. The dissected phrenic nerve was taken out through thoracic inlet and neck wound and then anastomosed to the musculocutaneous nerve through a subcutaneous tunnel. With chest films and fluoroscopy, levels and movements of diaphragm were measured before and after operation. RESULT: There was no specific technical difficulty or even minor postoperative complications following endoscopic division of phrenic nerve. After division of phrenic nerve, diaphragm was soon elevated about 1.7 intercostal spaces compared with the preoperative level, but it did not show paradoxical motion in fluoroscopy. More than 1.5 months later, diaphragm returned downward close to the preoperative level (average level difference was 0.9 intercostal spaces; p=NS). Movement of diaphragm was not significantly decreased compared with the preoperative one.
CONCLUSION
After division of phrenic nerve, the affected diaphragm did not show a significant decrease in movement, and the elevated diaphragm returned downward with time. However, the decreased lung volumes in the last spirometry suggest the decreased inspiratory force following partial paralysis of diaphragm.

Keyword

Diaphragm; Phrenic nerve; Diaphragmatic, physiopathology; Diaphragmatic eventration; Endoscopic surgical procedure

MeSH Terms

Bays
Brachial Plexus
Diaphragm
Diaphragmatic Eventration
Endoscopy
Fluoroscopy
Humans
Intercostal Nerves
Lung
Musculocutaneous Nerve
Neck
Nerve Transfer
Paralysis
Phrenic Nerve*
Postoperative Complications
Spirometry
Thorax
Transplants
Wounds and Injuries
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