Epilogue

Abstract

Narakas preferred to use the following incisions for a complete exposure of the brachial plexus [47, 48, 56, 78, 157]. In adults, the supraclavicular approach began with a zig-zag incision along the posterior border of the sternocleidomastoid muscle, following the upper border of the clavicle and continuing above the deltopectoral groove. In obstetric lesions one can confine oneself to a tranverse incision 2 cm above the clavicle, which is sufficient to expose the lesion. Supraclavicular dissection follows division of the platysma, attempting to save the sensory branches of the cervical plexus. Reference marks are the anterior scalene muscle, on which the phrenic nerve is identified. This nerve is followed proximally to look for the spinal nerve C4 and then to identify the spinal nerves C5, C6, C7 (or their empty foramina), guided by the coure of the omohyoid muscle which covers the suprascapular nerve. It is also important to look for the profound transverse cervical arteries, which pass over the spinal nerve C7.