Trapezius branch of cervical plexus as donor nerve in double free muscle transfer.

To The Editor: We appreciate that, among the surgical treatments for patients who have sustained complete or almost complete avulsion of the brachial plexus, the one described by Doi et al. in their article "Restoration of Prehension with the Double Free Muscle Technique Following Complete Avulsion of the Brachial Plexus. Indications and Long-Term Results" (2000;82:652-66), is the best. They use the spinal accessory nerve as a donor nerve to reinnervate the transferred gracilis muscle at the first stage of the operation. We performed the double free muscle technique in twelve patients, but in four of them the spinal accessory nerve did not function satisfactorily, as a result of the primary injury, and therefore was unavailable. In three of those four patients, we used the trapezius branch of the cervical plexus as our modification of this operation. This double muscle technique involves a two-stage reconstruction. In the first operation, free muscle is transferred to restore elbow flexion and finger extension. The spinal accessory nerve is used to reinnervate the transferred muscle. In the second operation, muscle is transferred to restore finger flexion, with use of the fifth and sixth intercostal nerves to reinnervate the transferred muscle. We tried …