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Original article
peer-reviewed

Intercostal Nerve to Long Thoracic Nerve Transfer for the Treatment of Winged Scapula: A Cadaveric Feasibility Study



Abstract

There are very few surgical options available for treating a patient with winged scapula caused by a long thoracic nerve (LTN) injury. Therefore, we devised a novel technique based on a cadaveric dissection whereby regional intercostal nerves (ICN) were harvested and transposed to the adjacent LTN in 10 embalmed cadavers (20 sides). The LTN was identified along the lateral border of the serratus anterior and ICNs were identified at the mid-axillary line inferior to the lower edge of the pectoralis major muscle. Along the mid-clavicular line, each ICN was transected and transposed to the adjacent LTN. The length and diameter of each ICN available for mobilization to the LTN were measured. All measurements were made with microcalipers. Within the operative site, the mean proximal and distal diameters of the LTN were 1.6 and 1.1 mm, respectively. The adjacent ICN had a mean diameter of 1.3 mm. On all sides, the ICN branches were easily transposed to the adjacent LTN without any tension. Anastomosis to the LTN was performed to the third through sixth ICN provided each intercostal was preserved and mobilized anteriorly at least as far as the midclavicular line. The end to end size match between donor and LTN was appropriate on all sides. We found that it is feasible to harvest adjacent ICNs and move these to the adjacent LTN. Such a procedure, after being confirmed in patients, might offer a new technique for restoring protraction following an LTN injury.



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Original article
peer-reviewed

Intercostal Nerve to Long Thoracic Nerve Transfer for the Treatment of Winged Scapula: A Cadaveric Feasibility Study


Author Information

Robert G. Louis Jr

Department of Anatomical Sciences, St. George's University, Grenada, Skull Base and Pituitary Tumor Program, Hoag Memorial Hospital, Newport Beach, Ca

Joshua D. Whitesides Corresponding Author

Department of Anatomical Sciences, St. George's University School of Medicine, Grenada, West Indies

Theofanis F. Kollias

Department of Anatomical Sciences, St. George's University School of Medicine, Grenada, West Indies

Joe Iwanaga

Seattle Science Foundation

R. Shane Tubbs

Neurosurgery, Seattle Science Foundation

Marios Loukas

Department of Anatomical Sciences, St. George's University School of Medicine, Grenada, West Indies


Ethics Statement and Conflict of Interest Disclosures

Human subjects: All authors have confirmed that this study did not involve human participants or tissue. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.


Original article
peer-reviewed

Intercostal Nerve to Long Thoracic Nerve Transfer for the Treatment of Winged Scapula: A Cadaveric Feasibility Study


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Original article
peer-reviewed

Intercostal Nerve to Long Thoracic Nerve Transfer for the Treatment of Winged Scapula: A Cadaveric Feasibility Study

Robert G. Louis Jr">Robert G. Louis Jr, Joshua D. Whitesides">Joshua D. Whitesides , Theofanis F. Kollias">Theofanis F. Kollias, Joe Iwanaga">Joe Iwanaga, R. Shane Tubbs">R. Shane Tubbs, Marios Loukas">Marios Loukas

  • Author Information
    Robert G. Louis Jr

    Department of Anatomical Sciences, St. George's University, Grenada, Skull Base and Pituitary Tumor Program, Hoag Memorial Hospital, Newport Beach, Ca

    Joshua D. Whitesides Corresponding Author

    Department of Anatomical Sciences, St. George's University School of Medicine, Grenada, West Indies

    Theofanis F. Kollias

    Department of Anatomical Sciences, St. George's University School of Medicine, Grenada, West Indies

    Joe Iwanaga

    Seattle Science Foundation

    R. Shane Tubbs

    Neurosurgery, Seattle Science Foundation

    Marios Loukas

    Department of Anatomical Sciences, St. George's University School of Medicine, Grenada, West Indies


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: All authors have confirmed that this study did not involve human participants or tissue. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

    Acknowledgements


    Article Information

    Published: November 30, 2017

    DOI

    10.7759/cureus.1898

    Cite this article as:

    Louis jr R G, Whitesides J D, Kollias T F, et al. (November 30, 2017) Intercostal Nerve to Long Thoracic Nerve Transfer for the Treatment of Winged Scapula: A Cadaveric Feasibility Study. Cureus 9(11): e1898. doi:10.7759/cureus.1898

    Publication history

    Received by Cureus: October 27, 2017
    Peer review began: November 20, 2017
    Peer review concluded: November 25, 2017
    Published: November 30, 2017

    Copyright

    © Copyright 2017
    Louis Jr et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

There are very few surgical options available for treating a patient with winged scapula caused by a long thoracic nerve (LTN) injury. Therefore, we devised a novel technique based on a cadaveric dissection whereby regional intercostal nerves (ICN) were harvested and transposed to the adjacent LTN in 10 embalmed cadavers (20 sides). The LTN was identified along the lateral border of the serratus anterior and ICNs were identified at the mid-axillary line inferior to the lower edge of the pectoralis major muscle. Along the mid-clavicular line, each ICN was transected and transposed to the adjacent LTN. The length and diameter of each ICN available for mobilization to the LTN were measured. All measurements were made with microcalipers. Within the operative site, the mean proximal and distal diameters of the LTN were 1.6 and 1.1 mm, respectively. The adjacent ICN had a mean diameter of 1.3 mm. On all sides, the ICN branches were easily transposed to the adjacent LTN without any tension. Anastomosis to the LTN was performed to the third through sixth ICN provided each intercostal was preserved and mobilized anteriorly at least as far as the midclavicular line. The end to end size match between donor and LTN was appropriate on all sides. We found that it is feasible to harvest adjacent ICNs and move these to the adjacent LTN. Such a procedure, after being confirmed in patients, might offer a new technique for restoring protraction following an LTN injury.



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Robert G. Louis Jr

Department of Anatomical Sciences, St. George's University, Grenada, Skull Base and Pituitary Tumor Program, Hoag Memorial Hospital, Newport Beach, Ca

Joshua D. Whitesides, Medical Student

Department of Anatomical Sciences, St. George's University School of Medicine, Grenada, West Indies

For correspondence:
jwhitesi@sgu.edu

Theofanis F. Kollias

Department of Anatomical Sciences, St. George's University School of Medicine, Grenada, West Indies

Joe Iwanaga, Ph.D., Assistant Professor

Seattle Science Foundation

R. Shane Tubbs, Ph.D., Professor

Neurosurgery, Seattle Science Foundation

Marios Loukas

Department of Anatomical Sciences, St. George's University School of Medicine, Grenada, West Indies

Robert G. Louis Jr

Department of Anatomical Sciences, St. George's University, Grenada, Skull Base and Pituitary Tumor Program, Hoag Memorial Hospital, Newport Beach, Ca

Joshua D. Whitesides, Medical Student

Department of Anatomical Sciences, St. George's University School of Medicine, Grenada, West Indies

For correspondence:
jwhitesi@sgu.edu

Theofanis F. Kollias

Department of Anatomical Sciences, St. George's University School of Medicine, Grenada, West Indies

Joe Iwanaga, Ph.D., Assistant Professor

Seattle Science Foundation

R. Shane Tubbs, Ph.D., Professor

Neurosurgery, Seattle Science Foundation

Marios Loukas

Department of Anatomical Sciences, St. George's University School of Medicine, Grenada, West Indies