Pectoral Fascicle of the Middle Trunk to Spinal Accessory Nerve Transfer 1 Mackinnon SE1 Yee A1 December 9, 2011Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication.The pectoral fascicle of the middle trunk is an available donor nerve to transfer to restore spinal accessory nerve function. This procedure involves identifying the brachial plexus and the accessory nerve through a supraclavicular exposure. The pectoral fascicle is identified on the anterior aspect of the middle trunk deep to the identified upper trunk. Typically, two pectoral fascicles are identified and the fascicle that elicits a stronger contraction during electrical stimulation is utilized for transfer. The accessory nerve is identified along and deep to the anterior border of the trapezius. In this specific case, the patient had a proximal iatrogenic accessory nerve injury following a carotid endarterectomy four months prior to surgery, which precluded a direct repair of the accessory nerve.Keywords: middle trunksupraclavicular exposureinterfascicular dissectionbrachial plexusiatrogenic injurynerve transfershoulder functionpectoral fascicle of middle trunknerve injuryspinal accessory nerve You must login to view the full article and extended video on this page. Standard Edition Table of Contents- Slow down- Frustration00:00:00 - Introduction00:00:10 - Orientation00:00:20 - Incision00:00:35 - Exposure through the Platysma and Identifying the Supraclavicular Nerve Branches00:01:12 - Identification of the Trapezius Anterior Border00:01:40 - Partially Releasing the Trapezius Anterior Border00:02:01 - Identifying the Spinal Accessory Nerve00:02:23 - Electrical Stimulation of the Spinal Accessory Nerve00:03:22 - Identifying and Releasing the Omohyoid00:03:44 - Identifying the Long Thoracic Nerve00:04:04 - Identification of the Upper Trunk and Middle Trunk00:04:38 - Intraneurolysis of the Pectoral Fascicles from the Middle Trunk00:05:43 - Electrical Stimulation of the Pectoral Fascicles00:06:06 - Distal Transection of the Pectoral Fascicle00:06:37 - Proximal Transection of the Spinal Accessory Nerve00:07:13 - Pectoral Fascicle to Spain Accessory Nerve Transfer You must login to view the full article and extended video on this page. Leave a Comment Cancel replyYou must be logged in to post a comment.