Abstract
For surgeries aimed at the dissection of full-length phrenic nerve, a full appreciation of its trajectory, blood supply and correlation with adjacent anatomical structures is necessary, especially for endoscopic manipulations. A fresh cadaver study was conducted with the purpose of avoiding surgical complications and ensuring further efficacy and efficiency of endoscopic manipulations. Ten fresh adult cadavers were dissected. Special attention was paid to the topography of the origin, the trajectory of the phrenic nerve, and its anatomic communication with the surrounding vessels and organs. In the second side of the cadavers, thoracic endoscopic manipulations and observations were also performed. The full length of the phrenic nerve was 24.6 ± 1.7 and 30.6 ± 1.8 cm on the right and left side, respectively; the blood supply of the phrenic nerve in the thoracic cavity came exclusively from the pericardiacophrenic artery; the distance between the origin of the pericardiacophrenic artery and that of the internal thoracic artery ranged from 0.5 to 5.2 cm on the right side, and from 1.4 to 5.6 cm on the left; most of the pericardiacophrenic veins intermingled with small vessels of pericardium and pleura, forming a venous network and joining the innominate vein. Endoscopic dissection of the thoracic phrenic nerve together with the accompanying pericardiacophrenic artery can be performed. Extreme attention should be paid during surgery to a section of about 6 cm in length of the artery originating from the internal thoracic artery, while the accompanying veins do not require to be spared.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Banneheka S (2008) Morphological study of the ansa cervicalis and the phrenic nerve. Anat Sci Int 83(1):31–44
Bhandari PS, Sadhotra LP, Bhargava P et al (2009) Surgical outcomes following nerve transfers in upper brachial plexus injuries. Indian J Plast Surg 42(2):150–160
Canella C, Demondion X, Delebarre A, Moraux A, Cotten H, Cotten A (2010) Anatomical study of phrenic nerve using ultrasound. Eur Radiol 20:659–665
Chuang DC, Mardini S (2003) Extended phrenic nerve transfer. Plast Reconstr Surg 112(1):354–356
Deng Y, Byth K, Paterson HS (2003) Phrenic nerve injury associated with high free right internal mammary artery harvesting. Ann Thorac Surg 76(2):459–463
Fell SC (1998) Surgical anatomy of the diaphragm and the phrenic nerve. Chest Surg Clin N Am 8(2):281–294
Gu YD, Wu MM, Zhen YL et al (2002) Phrenic nerve transfer for brachial plexus motor neurotization. Microsurgery 10(4):287–289
Henriquez-Pino J, Mandiola-Lagunas E, Prates JC (1993) Origin of the internal thoracic artery and its relationship to the phrenic nerves. Surg Radiol Anat 15:31–34
O’Brien JW, Johnson SH, VanSteyn SJ et al (1991) Effects of internal mammary artery dissection on phrenic nerve perfusion and function. Ann Thorac Surg 52:182–188
Paraskevas GK, Raikos A, Chouliaras K, Papaziogas B (2011) Variable anatomical relationship of phrenic nerve and subclavian vein: clinical implication for subclavian vein catheterization. Br J Anaesth 106(3):348–351
Prakash, Prabhu LV, Madhyastha S, Singh G (2007) A variation of the phrenic nerve: case report and review. Singapore Med J 48(12):1156–1157
Sinis N, Boettcher M, Werdin F, Kraus A, Schaller HE (2009) Restoration of shoulder abduction function by direct muscular neurotization with the phrenic nerve fascicles and nerve grafts: a case report. Microsurgery 29(7):552–555
Siqueira MG, Martins RS (2009) Phrenic nerve transfer in the restoration of elbow flexion in brachial plexus avulsion injuries: how effective and safe is it? Neurosurgery 65(4 Suppl):A125–A131
Songcharoen P, Wongtrakul S, Spinner RJ (2005) Brachial plexus injuries in the adult. Nerve transfers: the Siriraj Hospital experience. Hand Clin 21(1):83–89
Standring S (ed) (2004) Gray’s anatomy, 39th edn, vol 554. Chapters 3.1 (Neck), and 6.4 (Diaphragm and phrenic nerve). Churchill Livingstone, London
Tripp HF, Bolton JW (1998) Phrenic nerve injury following cardiac surgery: a review. J Card Surg 13(3):218–223
Xu WD, Gu YD, Xu JG, Tan LJ (2002) Full-length phrenic nerve transfer by means of video-assisted thoracic surgery in treating brachial plexus avulsion injury. Plast Reconstr Surg 110(1):104–109 (discussion 110–111)
Xu WD, Lu JZ, Qiu YQ et al (2008) Hand prehension recovery after brachial plexus avulsion injury by performing a full-length phrenic nerve transfer via endoscopic thoracic surgery. J Neurosurg 108(6):1215–1219
Yang JY, Chen L, Gu YD, Chen DS, Wang T (2011) Selective neurotization of the radial nerve in the axilla using a full-length phrenic nerve to treat complete brachial plexus palsy: an anatomic study and case report. Neurosurgery 68(6):1648–1653
Zhao X, Lao J, Hung LK, Zhang GM, Zhang LY, Gu YD (2004) Selective neurotization of the median nerve in the arm to treat brachial plexus palsy. An anatomic study and case report. J Bone Joint Surg Am 86-A(4):736–742
Zhao X, Lao J, Hung LK, Zhang GM, Zhang LY, Gu YD (2005) Selective neurotization of the median nerve in the arm to treat brachial plexus palsy. Surgical technique. J Bone Joint Surg Am 87 Suppl 1(Pt 1):122–135
Conflict of interest
The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Jiang, S., Xu, WD., Shen, YD. et al. An anatomical study of the full-length phrenic nerve and its blood supply: clinical implications for endoscopic dissection. Anat Sci Int 86, 225–231 (2011). https://doi.org/10.1007/s12565-011-0114-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12565-011-0114-x