Posterior approach technique for accessory‐suprascapular nerve transfer: A cadaveric study of the anatomical landmarks and number of myelinated axons

Abstract

Accessory-suprascapular nerve transfer by the anterior supraclavicular approach technique was suggested to ensure transferrance of the spinal accessory nerve to healthy recipients. However, a double crush lesion of the suprascapular nerve might not be sufficiently demonstrated. In that case, accessory-suprascapular nerve transfer by the posterior approach would probably solve the problem. The aim of this study was to evaluate the anatomical landmarks and histomorphometry of the spinal accessory and suprascapular nerve in the posterior approach. Dissection of fresh cadaveric shoulder in a prone position identified the spinal accessory and suprascapular nerve by the trapezius muscle splitting technique. After that, nerves were taken for histomorphometric evaluation. The spinal accessory nerve was located approximately halfway between the spinous process and conoid tubercle. The average distance from the conoid tubercle to the suprascapular nerve (medial edge of the suprascapular notch) is 3.3 cm. The mean number of myelinated axons of the spinal accessory and suprascapular nerve was 1,603 and 6,004 axons, respectively. The results of this study supported the brachial plexus reconstructive surgeons, who carry out accessory-suprascapular nerve transfer by using the posterior approach technique. This technique is an alternative for patients who have severe crushed injury of the shoulder or suspected double crush lesion of the suprascapular nerve.

An anatomic study of the spinal accessory nerve: Extended harvest permits direct nerve transfer to distal plexus targets

“…Cross sectional images of the stained nerve were captured by using a light microscope (Nikon Eclipse 50i), connected to a digital camera (Nikkon Coolpix 4500). The digital images were enlarged and the number of myelinated axons were counted (Pruksakorn et al, 2007).…”

“…Recently, the posterior approach for nerve transfer of the SAN has been described by several authors (Bahm et al, 2005, Guan et al, 2006Mackinnon and Colbert, 2006;Pruksakorn et al, 2007). However, these authors did not demonstrate the maximal length of nerve that could be harvested, and whether or not the extended length harvest could reach additional anterior or more distal posterior targets.…”

Dual Nerve Transfers for Restoration of Shoulder Function After Brachial Plexus Avulsion Injury

“…1,2 For patients with brachial plexus injuries, restoration of the shoulder and elbow function is of great importance and priority. [3][4][5][6][7][8][9] Both these functions should be restored as long as there are sufficient donor nerves. So far, nerve transfer has been accepted as a reliable method for restoring shoulder function in cases with early presentation, especially in root avulsion injuries.…”

Transfer of Pectoral Nerves to Suprascapular and Axillary Nerves: An Anatomic Feasibility Study

“…We conducted a feasibility study for the transfer of the middle branch (1784 myelinated axons) and the inferior branch (1455 myelinated axons) of the pectoral nerves to the suprascapular nerve (6000 myelinated axons). 15,21 In this transfer, the number of axons in the donor nerves is 30% (middle branch) or 24% (inferior branch) of the recipient nerve, and based on the animal work reported by Totosy de Zepetnek, it has a high probability of successfully reinnervating the muscle. 22 In comparison, the spinal accessory nerve is 27% (1600 myelinated axons) of the recipient nerve.…”

“…22 In comparison, the spinal accessory nerve is 27% (1600 myelinated axons) of the recipient nerve. 21 The main drawback in the transfer of the pectoral nerves is the loss of pectoralis function. However, the synergistic latissimus dorsi muscle can compensate shoulder adduction and internal rotation.…”