Phrenic Nerve Transfer to Musculocutaneous Nerve: An Anatomical and Histological Study

Abstract

Background: To restore elbow flexor muscle function in case of traumatic brachial plexus avulsion, the phrenic nerve transfer to the musculocutaneous nerve has become part of clinical practice. The nerve transfer can be done by means of video-assisted thoracic surgery without nerve graft or via supraclavicular approach in combination with an autograft. This study focuses on a detailed microscopic and macroscopic examination of the phrenic nerve. It will allow a better interpretation of existing clinical results and, thus, serve as a basis for future clinical studies. Material and Methods: An anatomical study was conducted on 28 body donors of Caucasian origin (female n = 14, male n = 14). A sliding caliper and measuring tape were used to measure the diameter and length of the nerves. Sudan black staining was performed on 15 µm thick cryostat sections mounted on glass slides and the number of axons was determined by the ImageJ counting tool. In 23 individuals, the phrenic nerve could be examined on both sides. In 5 individuals, however, only one side was examined. Thus, a total of 51 nerves were examined. Results: The mean length of the left phrenic nerves (33 cm (29–38 cm)) was significantly longer compared to the mean length of the right phrenic nerves (30 cm (24–33 cm)) (p p = 0.034. A negative correlation was registered between age and the nerve number of axons in left (0.742, p p = 0.197) phrenic nerves. The mean distance from the upper edge of the ventral ramus of the fourth cervical spinal nerve to the point of entrance of the musculocutaneous nerve between the two parts of the coracobrachialis muscle was 19 cm (range, 15–24 cm) for the right and 20 cm (range, 15–25 cm) for the left arm. Conclusions: If an accessory phrenic nerve is available, it presumably should be spared. Thus, in that case, a supraclavicular approach in combination with a nerve graft would probably be of advantage.

Keywords

• phrenic nerve transfer
• musculocutaneous nerve
• Sudan black staining
• supraclavicular approach
• respiratory function
• elbow flexor muscle function