I recently returned from Brazil, where my father and I performed a specialized surgery to help people who have breathing disorders. We inserted a phrenic nerve pacemaker on someone who is quadriplegic. My father, Dr. Abbott Krieger has developed an innovative surgical technique to reanimate the diaphram in severly injured patients, freeing them from a lifetime confined to a ventilator. The procedure provides phrenic nerve injury treatment.
The phrenic nerve pacemaker can be used for people who have a nonworking diaphragm. If the phrenic nerve was injured, the pacemaker stimulates it to in turn cause the diaphragm to pull air in the lungs. This is the “breathing circuit” that allows us to breathe on our own. The injury can come from previous surgery. It often comes from a spinal cord injury, resulting in paralysis. The phrenic nerve is always quiet, and never sends it signal to the body to breathe.
This was the case for the procedure we performed last week in Brazil. A man was shot in the neck, injuring his spinal cord. He could not breathe without a ventilator. The hope now is that with time the pacemaker will allow this man to breathe on his own, without a ventilator or a breathing tube.
The research behind the procedure and its development was done by Dr. Abbott Krieger, the father of Rodeo Drive Plastic Surgery’s Medical Director. Dr. Abbott Krieger did basic research on the concepts for this revolutionary surgery. He then pioneered its use clinically. The procedure uses a nerve transfer technique to allow the phrenic nerves to once again stimulate the diaphragm to move air, allowing patients to breathe without the need for a ventilator.
This is obviously not the usual plastic surgery, such as a breast augmentation procedure. But plastic surgery also includes doing specialized procedures on nerves, and this is the case with this breathing surgery in which the treatment is performed for injury to the phrenic nerve.
Here is some more background on this sort of breathing surgery:
Breathing pacemakers are indicated for patients with diaphragm paralysis who would otherwise be completely or partially dependent on mechanical ventilation so long as the phrenic nerve(s) and diaphragm(s) are intact. Patients with diseases in which there is progressive demyelination of the phrenic nerves (such as ALS) or weakening of the diaphragm muscle (such as muscular dystrophy) are generally poor candidates for diaphragm pacing.
Careful preoperative evaluation (phrenic nerve conduction studies, pulmonary function tests, etc.) would be indicated in all cases. Benefits of diaphragm pacing for diaphragm paralysis include:
• Improved respiratory function since the inhaled air is drawn into the lungs by the diaphragm under negative pressure, rather than being forced into the chest under positive pressure.
• Lower infection rates due to the reduction in suctioning, elimination of external humidifier and ventilator circuits, and the potential removal of the tracheostomy tube.
• Improved mobility, normalized breathing and speech patterns, ease of eating and drinking.
Tags: breathing surgery, phrenic nerve pacemaker, Plastic Surgery
