Abstract
There are very few surgical options available for treating a patient with winged scapula caused by a long thoracic nerve (LTN) injury. Therefore, we devised a novel technique based on a cadaveric dissection whereby regional intercostal nerves (ICN) were harvested and transposed to the adjacent LTN in 10 embalmed cadavers (20 sides). The LTN was identified along the lateral border of the serratus anterior and ICNs were identified at the mid-axillary line inferior to the lower edge of the pectoralis major muscle. Along the mid-clavicular line, each ICN was transected and transposed to the adjacent LTN. The length and diameter of each ICN available for mobilization to the LTN were measured. All measurements were made with microcalipers. Within the operative site, the mean proximal and distal diameters of the LTN were 1.6 and 1.1 mm, respectively. The adjacent ICN had a mean diameter of 1.3 mm. On all sides, the ICN branches were easily transposed to the adjacent LTN without any tension. Anastomosis to the LTN was performed to the third through sixth ICN provided each intercostal was preserved and mobilized anteriorly at least as far as the midclavicular line. The end to end size match between donor and LTN was appropriate on all sides. We found that it is feasible to harvest adjacent ICNs and move these to the adjacent LTN. Such a procedure, after being confirmed in patients, might offer a new technique for restoring protraction following an LTN injury.
Highlights
Modern surgical options for the treatment of brachial plexus injuries include nerve grafting of viable nerve roots, nerve transfers, free-functioning muscle transfers, tendon transfers and combinations of these techniques [1]
The intercostal nerves (ICN) branches were transposed to the adjacent long thoracic nerve (LTN) without any tension
The end to end size match between donor and LTN was appropriate on all sides
Summary
Modern surgical options for the treatment of brachial plexus injuries include nerve grafting of viable nerve roots, nerve transfers, free-functioning muscle transfers, tendon transfers and combinations of these techniques [1]. After piercing the middle scalene muscle, the upper two roots (C5-C6) join the lower root (C7) dorsal to the brachial plexus and descend posterior to the first segment of the axillary artery to reach the serratus anterior muscle [2]. Travelling along the lateral surface of the serratus anterior muscle, adherent to the chest wall, the LTN supplies branches to each of its digitations. It binds the scapula to the lateral chest wall and enables other muscles to use it as a fixed site for movement of the upper limb [3]. The LTN is relatively unique among motor nerves in that it travels on the superficial surface of the muscle, which it innervates.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
