J Reconstr Microsurg 2017; 33(08): 592-595
DOI: 10.1055/s-0037-1603736
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Traumatic Suprascapular Nerve Injury at the Notch—A Reason for the Posterior Approach in Brachial Plexus Reconstruction

Marc A. Seifman
1   Plastic, Hand and Faciomaxillary Surgery Unit, The Alfred Hospital, Melbourne, Australia
2   Victorian Plastic Surgery Unit, St Vincent's Private Hospital East Melbourne, East Melbourne, Victoria, Australia
,
Scott Ferris
1   Plastic, Hand and Faciomaxillary Surgery Unit, The Alfred Hospital, Melbourne, Australia
2   Victorian Plastic Surgery Unit, St Vincent's Private Hospital East Melbourne, East Melbourne, Victoria, Australia
› Author Affiliations
Further Information

Publication History

07 February 2017

29 April 2017

Publication Date:
21 June 2017 (online)

Abstract

Background Optimal dynamic reconstruction of shoulder function requires a functional suprascapular nerve (SSN). Nerve transfer of the distal spinal accessory nerve (dSAN) to the SSN will in many cases restore very good supraspinatus and infraspinatus function. One potential cause of failure of this nerve transfer is an unrecognized more distal injury of the SSN. An anterior approach to this transfer does not allow for visualization of the nerve at the scapular notch which is a disadvantage when compared with a posterior approach to the SSN.

Methods All patients of the senior author (S.F.) with traumatic brachial plexus injuries undergoing spinal accessory nerve to SSN transfer via the posterior approach were analyzed.

Results Of the 58 patients, 11 (19.0%) demonstrated abnormal findings at the notch. In two of these 11 patients (18.2%), reconstruction was abandoned due to severe injury of the nerve. There was a higher rate of clavicular fractures in patients with SSN injuries at the notch, compared with no SSN injury at the notch (63.6 vs. 12.8%).

Conclusion The dSAN to SSN transfer is a reliable reconstruction for restoration of shoulder external rotation and abduction. There is a high proportion of injuries to the nerve at the notch, which can be best appreciated from a posterior approach. The authors, therefore, advocate a posterior approach for this nerve transfer.

 
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