Surgical Procedures

Pectoral Fascicle of the Middle Trunk to Spinal Accessory Nerve Transfer

The pectoral fascicle of the middle trunk is an available donor nerve to transfer to restore spinal accessory nerve function. This procedure involves identifying the brachial plexus and the accessory nerve through a supraclavicular exposure. The pectoral fascicle is identified on the anterior aspect of the middle trunk deep to the identified upper trunk. Typically, two pectoral fascicles are identified and the fascicle that elicits a stronger contraction during electrical stimulation is utilized for transfer. The accessory nerve is identified along and deep to the anterior border of the trapezius. In this specific case, the patient had a proximal iatrogenic accessory nerve injury following a carotid endarterectomy four months prior to surgery, which precluded a direct repair of the accessory nerve.

Standard 111202

Extended 111202




A supraclavicular incision that is 2cm superior and parallel to the border of the clavicle.


  1. Magill CK, Moore AM, Mackinnon SE. Same modality nerve reconstruction for accessory nerve injuries. Otolaryngol Head Neck Surg. 2008 Dec;139(6):854-6. PMID: 19041516.
  2. Novak CB, Mackinnon SE. Treatment of a proximal accessory nerve injury with nerve transfer. Laryngoscope. 2004 Aug;114(8):1482-4. PMID: 15280730.
  3. Novak CB, Mackinnon SE. Patient outcome after surgical management of an accessory nerve injury. Otolaryngol Head Neck Surg. 2002 Sep;127(3):221-4. PMID: 12297813.

Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication.

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