gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

Article

Send article

Use of reverse end-to-side suture to create a supercharge in spinal accessory nerve transfer to suprascapular nerve

Meeting Abstract

Search Medline for

  • presenting/speaker Joaquim Casanas - Traumaunit, Centro Medico Teknon, Sant Cugat del Valles, Spain
  • Manuel Llusa - Traumaunit, Centro Medico Teknon, Hospital Clínic de Barcelona, Departamento de Anatomía y Embriología Humana, UB, Sant Cugat del Valles, Spain
  • Isabel Fernandez Conejero - Traumaunit, Centro Medico Teknon, Sant Cugat del Valles, Spain
  • M. Rosa Morro - Traumaunit, Centro Medico Teknon, Hospital Clínic de Barcelona, Departamento de Anatomía y Embriología Humana, UB, Sant Cugat del Valles, Spain

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1103

doi: 10.3205/19ifssh1209, urn:nbn:de:0183-19ifssh12092

Published: February 6, 2020

© 2020 Casanas et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objectives/Interrogation: Nerve transfer has clearly shown to be a great technique to restore some nerve palsies.

Spinal accessory to suprascapular is probably one of the most popular nerve transfers to restore shoulder function. The use of intraoperative nerve recording to measure the amount of nerve action potential (NAP) transfered has added an important value to expect a successful results. In addition, in cases where some residual nerve conduction in the receptor nerve is detected, the use of reverse end-to-side suture (RETS) can be useful in order to do a supercharge. In those situations when donor nerve is not long enough to connect directly with the receptor nerve, a RETS with allogaft is indicated to fill in this gap.

Methods: Three men between 2015 and 2016 has been treated with a partial suprascapular function after brachial plexus lesion. Age ranges from 27 to 48 yo. When under brachial plexus revision, some residual function in suprascapular nerve is present, a RETS with spinal accessory nerve is indicated. In situations without suprascapular nerve transection from the upper trunk, a nerve gap is left, which we fill in with an allograft. Spinal accessory is transected when 150 mv level of NAP is identified. Termino-terminal suture with allograft is performed at that proximal level and end-to-side suture distally, to suprascapular nerve.

Evaluation is done with clinical function regarding shoulder abduction and external rotation and improvement in amplitude of suprascapular nerve conduction in postoperative nerve conduction studies.

Results and Conclusions: Spinal accessory nerve is recorded and transected when 150 mv are still present, when in suprascapular nerve at least 60 mV or some activity in CMAP is found, a RETS as a supercharge is indicated. The mean gap left was 3 cm and was covered by allograft.

The mean range of motion improved from 40 degree FA to 120º, and strength and update amplitude value went from 0.3 mV to 3.5 mV after 3 moths postop explained by reinnervation along allograft.

In conclusion, transfer enough NAP from donor nerve is crucial for successful results in nerve transfers, so we believe more proximal neurotomy with a high NAP and allograft interposition is preferable than an end-to-end suture with low NAP conduction in donor nerve.