408 Nerve to Subclavius for Neurotization Procedures: An Anatomical Feasibility Study

Abstract

INTRODUCTION: Injuries to the inferior trunk (IT) of the brachial plexus and its components can be debilitating. As such injuries are prioritized by surgeons during repair, an additional nerve transfer is considered. METHODS: 13 adult cadavers (26 sides) underwent dissection of the nerve to subclavius and proximal brachial plexus. Once the nerve was isolated from origin to termination, the C8 and T1 roots and IT were identified. The distal end of the nerve to subclavius was transected and swung to these roots and the IT. Once the nerves to subclavius were transposed and in a tension-free manner, the length of excess nerve following being brought to each of these nerves was measured. RESULTS: A nerve to subclavius originated from the superior trunk and traveled anterior to the middle and inferior trunks on all sides. The mean diameter of the nerve to subclavius was 0.8 mm and the mean length was 57 mm. After cutting the nerve to subclavius at its entrance into the subclavius muscle, the distal nerve could be transferred tension free to the IT of the brachial plexus and T1 ventral ramus on all sides. The distal nerve to subclavius reached the T1 ventral ramus with an average of 18 mm of additional length and to the C8 ventral ramus with an average of 19 mm. The nerve also could be transferred to the IT of the brachial plexus with an average of 20 mm of additional length. The nerve to subclavius was found to have approximately 3,000 axons. CONCLUSIONS: To our knowledge, use of the nerve to subclavius has previously not been used for nerve transfer procedures. Based on our cadaveric study, this often-overlooked nerve can be easily transposed to other regional nerves such as the IT of the brachial plexus.