Study results, supporting the efficacy of phrenic nerve reconstruction surgery, from Matthew Kaufman, M.D., FACS, and colleagues at Hackensack Meridian Jersey Shore University Medical Center were recently published in the Annals of Plastic Surgery.1
Dr. Kaufman, medical director of the academic medical center’s Center for Paralysis and Reconstructive Nerve Surgery has pioneered phrenic nerve reconstruction. As a board-certified plastic and reconstructive and otolaryngology-head and neck surgeon, he understands how to reconstruct and treat peripheral nerve injuries. In 2007, he began applying those skills in innovative ways to successfully treat phrenic nerve injuries and diaphragmatic paralysis.
Diaphragmatic paralysis due to phrenic nerve injury may cause orthopnea, exertional dyspnea, and sleep-disordered breathing. This publication evaluates the outcomes of 400 patients who underwent phrenic nerve reconstruction for diaphragmatic paralysis at two tertiary treatment centers between 2007 and 2019, utilizing various subjective and objective outcome measures.
Among the sample, statistically significant improvements were observed in a number of outcome measures obtained through Respiratory Testing, Electrodiagnostic Testing, Radiographic Assessment and standardized quality of life surveys. The findings of this study conclude that phrenic nerve reconstruction is an effective first-line treatment for properly selected patients with symptomatic diaphragmatic paralysis. Incremental recovery over at least 2 years and reactivation of diaphragm contractility can lead to substantial symptomatic relief and an improvement in respiratory function.
This surgery enables individuals with diaphragm paralysis from spinal cord injury, as well as others who have isolated phrenic nerve injuries following surgery, accident, or ‘wear and tear,’ to breathe without a ventilator or breath more easily again. Phrenic nerve damage typically occurs after surgery on the neck or chest, from trauma or among laborers who routinely work with their arms over their heads. In this landmark study, it was also demonstrated that phrenic nerve reconstruction can be selectively utilized for patients diagnosed with “idiopathic” or unknown causes of diaphragm paralysis. This is sometimes called Parsonage-Turner syndrome.
Patients have come to Jersey Shore University Medical Center for the surgery from around the U.S. and the world, including countries such as Japan, South Africa, Bolivia, Israel and Australia. The procedure typically entails borrowing a nerve from the patient’s calf to bypass the damaged phrenic nerve and rerouting nerve connections in the neck to support the new phrenic nerve.
Significant recovery is required, sometimes years, and may include intense and dedicated physical therapy that incorporates cardiovascular exercise, muscle strengthening and/or breathing exercises depending on the nature of the damage.
“Dr. Kaufman’s phrenic nerve reconstruction surgery is a great example of the innovative care available for patients at our academic medical center,” said Kenneth N. Sable, M.D., MBA, FACEP, Hackensack Meridian Health, regional president, southern market.
For information about the Center for Paralysis and Reconstructive Nerve Surgery, part of the Neuroscience Institute at Jersey Shore University Medical Center, visit https://www.jerseyshoreuniversitymedicalcenter.com/services/center-for-paralysis-and-reconstructive-nerve-surgery/.
1 Phrenic Nerve Reconstruction for Effective Surgical Treatment of Diaphragmatic Paralysis, Annals of Plastic Surgery: May 12, 2021, Kaufman, Matthew R. MD; Chang, Eric I. MD; Bauer, Thomas MD; Rossi, Kristie BS; Elkwood, Andrew I. MD; Paulin, Ethan MD; Jarrahy, Reza MD
