In total brachial plexus injury when ipsilateral spinal accessory nerve is also traumatized we offer the use of contralateral SAN as an additional option in the reinnervation of suprascapular nerve.
Technique-
Through a transverse incision over the spine of scapula, the distal part of suprascapular nerve (SSN) is dissected up to the suprascapular notch. SSN is divided at its origin from the upper trunk and delivered through the scapular incision. Through another incision over the contralateral scapular spine, the spinal accessory nerve (SAN) is dissected free, while preserving its branches to the upper and middle parts of trapezius muscle. Distal vertical course of SAN is dissected along the medial border of scapula and the nerve is divided and delivered to the surface. A sural nerve graft is interposed between the ends of SAN and SSN and nerve coaptations are carried out with 10-0 nylon suture under an operating microscope.
Discussion
In panbrachial plexus injury root avulsions are common and at times associated with injury to the donor nerves (e.g phrenic and SAN). Histomorphometric studies have suggested an adequacy of myelinated axons in the distal part of spinal accessory nerve. Based on this we have used the contralateral SAN lengthened with a graft to reinnervate the injured SSN. We consider the use of contralateral SAN is a viable option in restoration of shoulder function.
