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Original Research: CARDIOTHORACIC SURGERY |

Reinnervation of the Paralyzed DiaphragmSurgical Reinnervation of the Paralyzed Diaphragm: Application of Nerve Surgery Techniques Following Unilateral Phrenic Nerve Injury

Matthew R. Kaufman, MD; Andrew I. Elkwood, MD; Michael I. Rose, MD; Tushar Patel, MD; Russell Ashinoff, MD; Adam Saad, MD; Robert Caccavale, MD; Jean-Philippe Bocage, MD; Jeffrey Cole, MD; Aida Soriano, MD, FCCP; Ed Fein, MD
Author and Funding Information

From the Department of Surgery (Drs Kaufman, Elkwood, Rose, Patel, and Ashinoff), Institute for Advanced Reconstruction, Shrewsbury, NJ; Department of Surgery (Drs Kaufman and Saad), Drexel College of Medicine, Philadelphia, PA; Thoracic Group (Drs Caccavale and Bocage), Somerset, NJ; Kessler Institute for Rehabilitation (Dr Cole), West Orange, NJ; Somerset Pulmonary/Critical Care Asthma and Sleep Center (Dr Soriano), Somerset, NJ; and Robert Wood Johnson University Hospital (Dr Fein), New Brunswick, NJ.

Correspondence to: Matthew R. Kaufman, MD, The Plastic Surgery Center, 535 Sycamore Ave, Shrewsbury, NJ 07702; e-mail: kaufmanmatthew@hotmail.com


Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(1):191-197. doi:10.1378/chest.10-2765
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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.

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