Reconstruction of accessory nerve defects with vascularized long thoracic vs. non-vascularized thoracodorsal nerve

Modern techniques of lymph-node neck dissection aim at conserving the accessory nerve. However, its continuity cannot be retained in cases of tumor in its direct neighborhood. In these cases, the accessory nerve must be resected for oncologic reasons. This study reports on neuronal reconstruction with both a vascularized long thoracic nerve transfer and a free thoracodorsalis nerve transfer, and compares the two. Both nerve transfers were removed simultaneously with an osseo-myocutaneous scapula-latissimus dorsi transfer. In both cases, morphologic reconstruction in the face and a neuro-functional reconstruction of the shoulder-arm region is possible. The vascularized long thoracic nerve transfer was superior to the non-vascularized throacodorsalis transfer for patients who had undergone radiotherapy. It resulted in more rapid healing and an improved motor result in shoulder elevation and maximal arm abduction. The long thoracic nerve transfer should thus be favored in reconstruction of the accessory nerve following tumor resection.