For patients whose phrenic nerve(s) no longer conduct due to direct trauma, nerve grafting may be an option. Any grafting procedure would likely need to be performed before the diaphragm muscle fibers undergo irreversible degeneration, after which time it will be impossible to reverse the loss of conduction. Sometimes, if patients have a partial nerve injury there will be enough electrical input into the diaphragm to keep the muscle fibers alive, however insufficient input to allow the diaphragm to contract. Under those circumstances we may be able to help individuals whose injury occurred many years ago. A pre-operative phrenic nerve conduction study and diaphragm EMG is the only way to determine if a nerve graft may be possible. In our own patient experience, we have been able to restore diaphragm function in a few patients whose diaphragm paralysis occurred greater than 5 years earlier.
There are several nerve graft or nerve transplant options to restore function to the diaphragm. One method involves harvesting the sural nerve from the leg and using it to bypass the site or area of the injury in the neck or chest. Another method involves transferring a functioning nerve, such as the intercostal nerve or spinal accessory nerve, to the phrenic nerve in order to regain diaphragm function. At the Institute for Advanced Reconstruction, our surgical pioneers have developed many of these procedures and have been successful using one or more of these methods in the vast majority of patients treated. Since nerves grow at approximately 1 mm per day, it takes several months for the diaphragm to regain function.
The only way to know if you would be a candidate for any of these procedures would be to contact us in our New Jersey offices. We have staff that knows exactly what you or your loved one is going through, and we would be happy to answer any questions you may have.