Ongoing Clinical Challenges in Nerve Surgery (Nerve SPACE 2025).

Area of Science:

• Peripheral nerve surgery and rehabilitation.
• Regenerative medicine and neuroprosthetics.

Background:

• Significant advancements in the last decade have expanded therapeutic options for nerve injuries, tumors, and limb loss.
• Key areas include nerve allografts, nerve wraps, peripheral nerve sheath tumor treatment, and bionic limb technology.
• Rehabilitation strategies have also seen improvements, notably through approaches like the Donor Activation Focused Rehabilitation Approach.

Purpose of the Study:

• To review current progress in peripheral nerve surgery and rehabilitation.
• To identify areas requiring further research and development.
• To outline strategies for future advancements in the field.

Main Methods:

• Review of recent literature and technological advancements.
• Analysis of current therapeutic landscapes and their limitations.
• Identification of research gaps and future directions.

Main Results:

• Nerve allografts show promise for specific nerve gaps, but outcomes for proximal injuries are debated.
• The efficacy of nerve wraps and connectors remains controversial due to material variability and limited high-quality studies.
• Bionic limb technology has advanced, yet challenges like prosthetic abandonment, phantom limb pain, and cost persist.

Conclusions:

• Further research is essential to establish effective rehabilitation protocols and clarify the roles of different grafting and wrapping techniques.
• Improved diagnostic tools and systemic therapies are needed for peripheral nerve sheath tumors.
• Future bionic limb development should focus on intuitive control, sensory feedback, pain management, and equitable access.