PURPOSE

We seek to describe our experience with reverse end-to- side (RETS) transfer of the spinal accessory nerve to the

suprascapular nerve in the reconstruction of brachial plexus birth injury (BPBI).

METHODS

Retrospective review was performed from 2016-2021 to identify BPBI patients who underwent RETS transfer of SAN to SSN. Concurrent botulinum toxin administration was performed in all cases. 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.

• Ratio of SAN-SSN diameter: 0.31 +/- .1

• RETS transfer of the SAN to the SSN was performed

  without tension in all 7 cases.

• No donor morbidity was noted in any patient.

• 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.

• No patients with significant trapezius wasting/atrophy.

• No patients have required a tendon transfer.