Bridging defects: autologous nerve grafts.

Area of Science:

• Neurosurgery
• Regenerative Medicine
• Peripheral Nerve Repair

Background:

• Autologous nerve grafting has a long history, with early attempts yielding limited success.
• The interfascicular nerve grafting technique, developed in the 1960s, offers reliable bridging of extensive nerve defects.
• Donor site morbidity associated with autografts is minimal when appropriate precautions are taken.

Purpose of the Study:

• To evaluate the long-term efficacy and safety of autologous nerve grafting.
• To discuss the role of alternative techniques in managing large nerve defects.
• To emphasize the supplementary role of tubulisation in nerve reconstruction.

Main Methods:

• Review of personal experience spanning over 40 years in nerve grafting.
• Analysis of donor site morbidity in relation to autologous nerve grafting.
• Assessment of the limitations of autografts in extensive defects, such as brachial plexus injuries.

Main Results:

• Autologous nerve grafting, particularly the interfascicular technique, provides predictable results for long nerve defects.
• Minimal donor site morbidity is achievable with careful surgical technique.
• The quantity of autografts is often insufficient for vast defects, necessitating alternative strategies.

Conclusions:

• Autologous nerve grafts remain a gold standard for peripheral nerve repair.
• Donor site morbidity does not preclude the use of autologous nerve grafts.
• Tubulisation and other alternative techniques should be considered as adjuncts to autologous nerve grafting, especially in cases of extensive nerve loss.