Journal of plastic, reconstructive & aesthetic surgery : JPRAS · 2026
Ultrasound versus surgical anatomical landmarks for localization of the spinal accessory and suprascapular nerves in posterior nerve transfer: A comparative clinical study.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Jerome J Terrence Jose, Surendran G, Thirumagal K
Аннотация
PURPOSE: Posterior spinal accessory nerve (SAN) to suprascapular nerve (SSN) transfer is a well-established procedure for restoration of shoulder function in upper brachial plexus injuries. Nerve localization traditionally relies on anatomical surface landmarks, which may be influenced by surgeon experience and patient-specific anatomy. Ultrasound provides direct visualization of neural and vascular landmarks before incision. We compared ultrasound-guided preoperative localization with conventional anatomical landmark-based localization during posterior SAN-to-SSN nerve transfer.
METHODS: In this prospective, nonrandomized comparative cohort study, 40 consecutive patients undergoing posterior SAN-to-SSN transfer were allocated in an alternating sequence to ultrasound-guided or landmark-based preoperative skin marking (20 patients per group). Outcomes included time to SAN and SSN identification, total operative time, and requirement for wider exploratory dissection.
RESULTS: Baseline demographic and injury characteristics were comparable between the groups. Ultrasound localization was associated with shorter time to SAN identification (12.0 ± 2.1 vs. 20.1 ± 3.0 min), SSN identification (58.2 ± 5.3 vs. 72.4 ± 6.1 min), and total operative time (110.4 ± 9.5 vs. 132.6 ± 11.3 min) (all p < 0.001). Wider exploratory dissection was required less frequently in the ultrasound group (15% vs. 60%; p = 0.004). Ultrasound mapping required a mean of 3.0 ± 0.5 min and did not eliminate the overall procedural time advantage when included in workflow analysis.
CONCLUSIONS: Preoperative ultrasound-guided skin marking was associated with more directed nerve localization, reduced exploratory dissection, and improved operative efficiency during posterior SAN-to-SSN nerve transfer. Ultrasound appears to be a useful adjunct that provides anatomically informed pre-incision guidance while maintaining an overall procedural time benefit.
LEVEL OF EVIDENCE: III, prospective nonrandomized comparative cohort study.
METHODS: In this prospective, nonrandomized comparative cohort study, 40 consecutive patients undergoing posterior SAN-to-SSN transfer were allocated in an alternating sequence to ultrasound-guided or landmark-based preoperative skin marking (20 patients per group). Outcomes included time to SAN and SSN identification, total operative time, and requirement for wider exploratory dissection.
RESULTS: Baseline demographic and injury characteristics were comparable between the groups. Ultrasound localization was associated with shorter time to SAN identification (12.0 ± 2.1 vs. 20.1 ± 3.0 min), SSN identification (58.2 ± 5.3 vs. 72.4 ± 6.1 min), and total operative time (110.4 ± 9.5 vs. 132.6 ± 11.3 min) (all p < 0.001). Wider exploratory dissection was required less frequently in the ultrasound group (15% vs. 60%; p = 0.004). Ultrasound mapping required a mean of 3.0 ± 0.5 min and did not eliminate the overall procedural time advantage when included in workflow analysis.
CONCLUSIONS: Preoperative ultrasound-guided skin marking was associated with more directed nerve localization, reduced exploratory dissection, and improved operative efficiency during posterior SAN-to-SSN nerve transfer. Ultrasound appears to be a useful adjunct that provides anatomically informed pre-incision guidance while maintaining an overall procedural time benefit.
LEVEL OF EVIDENCE: III, prospective nonrandomized comparative cohort study.