Contralateral spinal accessory nerve: a suitable "new" donor nerve for heterotopic nerve transfer in total brachial plexus palsy.

Patients with complete brachial plexus palsy with avulsion of 4-5 roots often have a paucity of suitable donor nerves to provide for a proper functional recovery of the upper extremity. The spinal accessory nerve is routinely employed ipsilaterally for nerve transfer to the suprascapular nerve. The purpose of this paper is to describe the clinical use of the contralateral spinal accessory nerve as a donor nerve for brachial plexus surgery. Since 2005 the contralateral spinal accessory nerve has been used for neurotization of the axillary nerve in selected cases of total brachial plexus injuries. In this paper total plexus palsy surgical strategies, technical details and preliminary functional outcomes of a group of 6 consecutive patients with a minimum follow-up of 30 months (76-31, average 55) are described. The preliminary results are encouraging: the functional outcome of the deltoid muscle, evaluated according to the British Medical Research Council grading system, was M4 in 1 patient, M3 in 1 patient, M2 in 2 patients, M1 in 1 patient, and M0 in 1 patient. In conclusion, the use of the contralateral spinal accessory nerve shows good results in terms of functional recovery and the simplicity of the procedure.