Аpproaches to accessory nerve

Accessory to suprascapular nerve transfer

Accessory to suprascapular nerve transfer
A linear skin incision (right side, marked with green) is made in the posterior neck triangle from the medial border of acromion scapuale to midline.
1. Superficial exposure
A linear skin incision (right side) is made in the posterior neck triangle from the medial border of acromion scapuale to midline. The trapezius m. fibers are split and the accessory nerve, dorsal branch is identified. The dissection plane filled with fatty tissie to fossa supraspinata is identified.
2. Transverse scapular ligament
The dorsal branch of the accessory n. is identified and dissected. The fat plane to fossa surpaspinata is dissected, the suprascapular artery and vein are identified. The transverse scapular ligament is identified.
3. Suprascapular nerve
The transverse scapular ligament is transected and the suprascapular n. is identified.
4. Accessory to suprascapular nerve anastomosis
A direct microsurgical anastomosis using 9.0 nylon suture is done between the dorsal branch of the accessory nerve and the suprascapular nerve.