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 acces sory nerve. However, its continuity cannot be retained in cases of tumor in its direct neighborhood. in these cases, the accessory nerve must be resec ted for oncologic reasons. This study reports on neuronal reconstruction wi th both a vascularized long thoracic nerve transfer and a free thoracodorsa lis nerve transfer, and compares the two. Both nerve transfers were removed simultaneously with an osseo-myocutaneous scapula-latissimus dorsi transfe r. In both cases, morphologic reconstruction in the face and a neuro-functi onal reconstruction of the shoulder-arm region is possible. The vascularize d long thoracic nerve transfer was superior to the non-vascularized throaco dorsalis transfer for patients who had undergone radiotherapy. It resulted in more rapid healing and an improved motor result in shoulder elevation an d maximal arm abduction. The long thoracic nerve transfer should thus be fa vored in reconstruction of the accessory nerve Following tumor resection.