, Volume 5, Issue 3, pp 313–317 | Cite as

Functional Recovery Following an End to Side Neurorrhaphy of the Accessory Nerve to the Suprascapular Nerve: Case Report

  • Wilson Z. Ray
  • Rahul Kasukurthi
  • Andrew Yee
  • Susan E. MackinnonEmail author
Case Reports


The use of end-to-side neurrorhaphy remains a controversial topic in peripheral nerve surgery. The authors report the long-term functional outcome following a modified end-to-side motor reinnervation using the spinal accessory to innervate the suprascapular nerve following a C5 to C6 avulsion injury. Additionally, functional outcomes of an end-to-end neurotization of the triceps branch to the axillary nerve and double fascicular transfer of the ulnar and medial nerve to the biceps and brachialis are presented. Excellent functional recoveries are found in respect to shoulder abduction and flexion and elbow flexion.


End-to-side Neurorrhaphy Collateral sprouting Neurotization Avulsion 

Supplementary material

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  1. 1.
    Akeda K, et al. Regenerating axons emerge far proximal to the coaptation site in end-to-side nerve coaptation without a perineurial window using a T-shaped chamber. Plast Reconstr Surg. 2006;117:1194–203. discussion 1204-1195.CrossRefPubMedGoogle Scholar
  2. 2.
    Asaoka K, Sawamura Y. Hypoglossal-facial nerve side-to-end anastomosis. J Neurosurg. 1999;91:163–4.PubMedGoogle Scholar
  3. 3.
    Asaoka K, Sawamura Y, Nagashima M, Fukushima T. Surgical anatomy for direct hypoglossal-facial nerve side-to-end "anastomosis". J Neurosurg. 1999;91:268–75.CrossRefPubMedGoogle Scholar
  4. 4.
    Bertelli JA, Ghizoni MF. Nerve repair by end-to-side coaptation or fascicular transfer: a clinical study. J Reconstr Microsurg. 2003;19:313–18.CrossRefPubMedGoogle Scholar
  5. 5.
    Bontioti E, Kanje M, Lundborg G, Dahlin LB. End-to-side nerve repair in the upper extremity of rat. J Peripher Nerv Syst. 2005;10:58–68.CrossRefPubMedGoogle Scholar
  6. 6.
    Brenner MJ, Dvali L, Hunter DA, Myckatyn TM, Mackinnon SE. Motor neuron regeneration through end-to-side repairs is a function of donor nerve axotomy. Plast Reconstr Surg. 2007;120:215–23.CrossRefPubMedGoogle Scholar
  7. 7.
    Colbert SH, Mackinnon S. Posterior approach for double nerve transfer for restoration of shoulder function in upper brachial plexus palsy. Hand (N Y). 2006;1:71–7.Google Scholar
  8. 8.
    Dvali LT, Myckatyn TM. End-to-side nerve repair: review of the literature and clinical indications. Hand Clin. 2008;24:455–60.CrossRefPubMedGoogle Scholar
  9. 9.
    Godefroy WP, Malessy MJ, Tromp AA, van der Mey AG. Intratemporal facial nerve transfer with direct coaptation to the hypoglossal nerve. Otol Neurotol. 2007;28:546–50.CrossRefPubMedGoogle Scholar
  10. 10.
    Goheen-Robillard B, Myckatyn TM, Mackinnon SE, Hunter DA. End-to-side neurorrhaphy and lateral axonal sprouting in a long graft rat model. Laryngoscope. 2002;112:899–905.CrossRefPubMedGoogle Scholar
  11. 11.
    Hayashi A, et al. Collateral sprouting occurs following end-to-side neurorrhaphy. Plast Reconstr Surg. 2004;114:129–37.CrossRefPubMedGoogle Scholar
  12. 12.
    Hayashi A, et al. Axotomy or compression is required for axonal sprouting following end-to-side neurorrhaphy. Exp Neurol. 2008;211:539–50.CrossRefPubMedGoogle Scholar
  13. 13.
    Hess JR, Brenner MJ, Myckatyn TM, Hunter DA, Mackinnon SE. Influence of aging on regeneration in end-to-side neurorrhaphy. Ann Plast Surg. 2006;57:217–22.CrossRefPubMedGoogle Scholar
  14. 14.
    Liverneaux PA, Diaz LC, Beaulieu JY, Durand S, Oberlin C. Preliminary results of double nerve transfer to restore elbow flexion in upper type brachial plexus palsies. Plast Reconstr Surg. 2006;117:915–19.CrossRefPubMedGoogle Scholar
  15. 15.
    Lundborg G, Zhao Q, Kanje M, Danielsen N, Kerns JM. Can sensory and motor collateral sprouting be induced from intact peripheral nerve by end-to-side anastomosis? J Hand Surg Br. 1994;19:277–82.CrossRefPubMedGoogle Scholar
  16. 16.
    Mackinnon SE. Preliminary results of double nerve transfer to restore elbow flexion in upper type brachial plexus palsies. Plast Reconstr Surg. 2006;118:1273. author reply 1274.Google Scholar
  17. 17.
    Mackinnon SE, Colbert SH. Nerve transfers in the hand and upper extremity surgery. Tech Hand Up Extrem Surg. 2008;12:20–33.CrossRefPubMedGoogle Scholar
  18. 18.
    Mackinnon SE, Roque B, Tung TH. Median to radial nerve transfer for treatment of radial nerve palsy. case report. J Neurosurg. 2007;107:666–71.CrossRefPubMedGoogle Scholar
  19. 19.
    Noah EM, Williams A, Fortes W, Terzis JK. A new animal model to investigate axonal sprouting after end-to-side neurorrhaphy. J Reconstr Microsurg. 1997;13:317–25.CrossRefPubMedGoogle Scholar
  20. 20.
    Noah EM, Williams A, Jorgenson C, Skoulis TG, Terzis JK. End-to-side neurorrhaphy: a histologic and morphometric study of axonal sprouting into an end-to-side nerve graft. J Reconstr Microsurg. 1997;13:99–106.CrossRefPubMedGoogle Scholar
  21. 21.
    Novak CB, Mackinnon SE. Treatment of a proximal accessory nerve injury with nerve transfer. Laryngoscope. 2004;114:1482–4.CrossRefPubMedGoogle Scholar
  22. 22.
    Novak CB, Mackinnon SE, Tung TH. Patient outcome following a thoracodorsal to musculocutaneous nerve transfer for reconstruction of elbow flexion. Br J Plast Surg. 2002;55:416–19.CrossRefPubMedGoogle Scholar
  23. 23.
    Okajima S, Terzis JK. Ultrastructure of early axonal regeneration in an end-to-side neurorrhaphy model. J Reconstr Microsurg. 2000;16:313–23. discussion 323-316.CrossRefPubMedGoogle Scholar
  24. 24.
    Papalia I, Geuna S, D'Alcontres FS, Tos P. Origin and history of end-to-side neurorrhaphy. Microsurgery. 2007;27:56–61.CrossRefPubMedGoogle Scholar
  25. 25.
    Ray WZ, Mackinnon SE. Management of nerve gaps: Autografts, allografts, nerve transfers, and end-to-side neurorrhaphy. Exp Neurol (2009), doi: 10.1016/j.expneurol.2009.03.031.
  26. 26.
    Rovak JM, Cederna PS, Kuzon WM Jr. Terminolateral neurorrhaphy: a review of the literature. J Reconstr Microsurg. 2001;17:615–24.CrossRefPubMedGoogle Scholar
  27. 27.
    Singh N, Robertson B, Dellon L. Use of an innervated tongue flap to rehabilitate the tongue after hypoglossal-to-facial nerve transfer. Plast Reconstr Surg. 2002;109:2439–42.CrossRefPubMedGoogle Scholar
  28. 28.
    Tarasidis G, et al. End-to-side neurorrhaphy resulting in limited sensory axonal regeneration in a rat model. Ann Otol Rhinol Laryngol. 1997;106:506–12.PubMedGoogle Scholar
  29. 29.
    Tarasidis G, et al. End-to-side neurorraphy: a long-term study of neural regeneration in a rat model. Otolaryngol Head Neck Surg. 1998;119:337–41.CrossRefPubMedGoogle Scholar
  30. 30.
    Tung TH, Liu DZ, Mackinnon SE. Nerve transfer for elbow flexion in radiation-induced brachial plexopathy: a case report. Hand (N Y). 2009;4:123–8.Google Scholar
  31. 31.
    Ueda K, et al. Combination of hypoglossal-facial nerve jump graft by end-to-side neurorrhaphy and cross-face nerve graft for the treatment of facial paralysis. J Reconstr Microsurg. 2007;23:181–7.CrossRefPubMedGoogle Scholar
  32. 32.
    Venail F, et al. Outcomes and complications of direct end-to-side facial-hypoglossal nerve anastomosis according to the modified May technique. J Neurosurg. 2009;110:786–91.CrossRefPubMedGoogle Scholar
  33. 33.
    Viterbo F, Trindade JC, Hoshino K, Mazzoni A. Two end-to-side neurorrhaphies and nerve graft with removal of the epineural sheath: experimental study in rats. Br J Plast Surg. 1994;47:75–80.CrossRefPubMedGoogle Scholar
  34. 34.
    Voche P, Ouattara D. End-to-side neurorrhaphy for defects of palmar sensory digital nerves. Br J Plast Surg. 2005;58:239–44.CrossRefPubMedGoogle Scholar
  35. 35.
    Zhang F, Fischer KA. End-to-side neurorrhaphy. Microsurgery. 2002;22:122–7.CrossRefPubMedGoogle Scholar
  36. 36.
    Zhang Z, et al. Repair of the main nerve trunk of the upper limb with end-to-side neurorrhaphy: an experimental study in rabbits. Microsurgery. 2006;26:245–52.CrossRefPubMedGoogle Scholar
  37. 37.
    Zhu QT, Zhu JK, Chen GY. Location of collateral sprouting of donor nerve following end-to-side neurorrhaphy. Muscle Nerve. 2008;38:1506–9.CrossRefPubMedGoogle Scholar

Copyright information

© American Association for Hand Surgery 2009

Authors and Affiliations

  • Wilson Z. Ray
    • 1
  • Rahul Kasukurthi
    • 2
  • Andrew Yee
    • 1
    • 2
  • Susan E. Mackinnon
    • 2
    Email author
  1. 1.Department of Neurological SurgeryWashington University School of MedicineSt. LouisUSA
  2. 2.Division of Plastic and Reconstructive SurgeryWashington University School of MedicineSt. LouisUSA

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