Free vascularized nerve transfer in the upper extremity

Free vascularized nerve transfer using microsurgical techniques for upper limb reconstruction should be considered as an alternative to conventional nonvascularized cable nerve grafts when the recipient bed is heavily scarred, as occurs in Volkmann's ischemia, when the nerve gap is exceptionally long, or when the free transfer of thick nerves is contemplated. Possible donor sites for free arteriovenous nerve transplants or arterialized neurovenous systems are presented and illustrated in four patients with follow-up in excess of 20 years. In each case the rate of axon immigration across the vascularized nerve-bridge and beyond to the hand was in excess of 1.5 mm per day.