PMC9407241_01
Ultrasound images, projection on the body surface and sensory block area of the supraclavicular nerve in Case 1: (A) ultrasound images of phrenic nerve (indicated with swallowtail arrow) and superficial cervical plexus (indicated with a thick white arrow); (B) ultrasound image of the supraclavicular nerve (indicated with a thick white arrow) anterior to the supraclavicular artery (indicated with a white arrowhead); (C) ultrasound images of branches of the supraclavicular nerve (indicated with thin white arrows) anterior to the clavicle (indicated with a cross arrow); (D) projection of the supraclavicular nerve on the body surface (indicated with a white arrow) and the sensory block area (red circle).
fsurg-09-898664-g001.jpg
PMC9407241_02_fsurg-09-898664-g001.jpg
F1
Under direct visualization, the nerve was located over the middle of the clavicle, and it extended beyond it (Figure 1C). A steel plate was placed under the supraclavicular nerve to prevent nerve injury (Figure 1C).
PMC9407241_02
Ultrasound images, projection on the body surface and sensory block area of the supraclavicular nerve in Case 1: (A) ultrasound images of phrenic nerve (indicated with swallowtail arrow) and superficial cervical plexus (indicated with a thick white arrow); (B) ultrasound image of the supraclavicular nerve (indicated with a thick white arrow) anterior to the supraclavicular artery (indicated with a white arrowhead); (C) ultrasound images of branches of the supraclavicular nerve (indicated with thin white arrows) anterior to the clavicle (indicated with a cross arrow); (D) projection of the supraclavicular nerve on the body surface (indicated with a white arrow) and the sensory block area (red circle).
fsurg-09-898664-g001.jpg
PMC9407241_02_fsurg-09-898664-g001.jpg
F1
Under direct visualization, the nerve was located over the middle of the clavicle, and it extended beyond it (Figure 1C). A steel plate was placed under the supraclavicular nerve to prevent nerve injury (Figure 1C).
Ultrasound images, projection on the body surface, sensory block area and intraoperative view of supraclavicular nerve in case 2: (A) ultrasound images of the supraclavicular nerve anterior to the clavicle; (B) projection of the supraclavicular nerve on the body surface and the sensory block area. (C) intraoperative view of the supraclavicular nerve. The thick white arrow indicates the supraclavicular nerve; the cross arrow indicates the clavicle.
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PMC9407241_02_fsurg-09-898664-g002.jpg
F2
Using our previous method, we identified the possible supraclavicular nerve by tracing it caudally from the superficial cervical plexus to where it crosses the clavicle (Figure 2A). Sensory blockade was evaluated as previously described (Figure 2B), and it proved that these suspected nerves were the medial and intermediate rami of the supraclavicular nerve.
PMC9407241_03
Ultrasound images, projection on body surface of the supraclavicular nerve, skin flap (bridge) and numbness area after the operation in case 3: (A) ultrasound images of the branches of the supraclavicular nerve at its origin (indicated with a thick white arrow); (B) ultrasound images of the branches of the supraclavicular nerve (indicated with a thin white arrow) anterior to the clavicle (indicated with a white cross arrow); (C) projection of the branches of the supraclavicular nerve on the body surface and skin flap (bridge) before the operation; (D) skin flap during the operation; (E) skin flap after the operation; and (F) numbness area after the operation.
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PMC9407241_03_fsurg-09-898664-g003.jpg
F3
Similarly, after intravenous injection of the sedative and analgesic, we used the previously described method to identify the three possible branches of the supraclavicular nerve at the surface of the clavicle (Figures 3A, B). The paths of these nerves were marked on the skin, and the incision line was designed to avoid damaging these nerves (Figure 3C). We made a horizontal incision, retaining a skin bridge (flap) over the nerve in the middle of the clavicle, and cutting the skin from both ends of the clavicle (Figures 3D, E). The steel plate was then placed over the periosteum of the clavicle through a subcutaneous tunnel (separation of the subcutaneous tissue and insertion of the plate were carefully performed tightly against the periosteum to minimize nerve injuries) (Figure 3D). The sensation in the areas below the medial two-thirds of the clavicle was normal (Figure 3F).