P138. REVERSE END-TO-SIDE SPINAL ACCESSORY TO SUPRASCAPULAR SUPERCHARGE NERVE TRANSFER FOR BRACHIAL PLEXUS BIRTH INJURY

Abstract

PURPOSE: We seek to describe our experience with reverse end-to-side (RETS) transfer of the spinal accessory (SAN) to the suprascapular (SSN) nerve in the reconstruction of brachial plexus birth injury (BPBI). METHODS: Retrospective review was performed from 2016-2020 to identify BPBI patients who underwent RETS transfer of SAN to SSN. Intraoperative images were reviewed, assessing proximity of SAN to SSN, as well as the relative diameter of the two nerves. Early outcomes were reviewed. RESULTS: Seven patients underwent RETS transfer of SAN to SSN. Mean age at operation was 10.8 ± 4 months. Intraoperative image review demonstrated close proximity of the distal SAN to the distal SSN in all cases. Diameter discrepancy between the SAN and SSN was recorded. RETS transfer of the SAN to the SSN was performed without tension in all 7 cases. No donor morbidity was noted in any patient. Concurrent Botox administration was performed in all cases. Average follow-up after reconstruction is 9.7 ± 10 months.All patients have demonstrated some degree of SSN functional recovery. At most recent follow up, 5 out of 7 patients demonstrate full passive ER; the two remaining are to 80 and 60 degrees. Evidence of early recovery of active external rotation has been observed in all patients. CONCLUSION: RETS transfer of the SAN to the SSN demonstrates potential to augment recovery of the SSN in the setting of neuroma-in-continuity. The technique provides an option for management of neuroma-in-continuity without a downgrade in function and without significant donor site morbidity.