Nerve grafting

For a long period, nerve grafting was used as a last resort when other means to manage a nerve defect failed. All attempts to apply allografts were disappointing. With the development of a new technique based on microsurgery, free nerve grafting has become a reliable method. The results are close to the results achieved by neurorrhaphy under favorable conditions and better than the results achieved by neurorrhaphy under tension. Today, this fact is recognized by nearly all surgeons. Discussion is limited only to the length of defect that still permits application of neurorrhaphy or represents an indication for nerve grafting. It is logical that different surgeons have different results, according to their training, their background, and the cases they have to treat. If the material contains more fresh cases, neurorrhaphy will be favored; if it contains more late secondary cases, nerve grafts will be applied in a higher frequency. The vascularized nerve graft is a new technique that certainly will have its indication in selected cases. If the immunologic problems connected with nerve grafting will be solved in one or the other way, a new era of nerve grafting will commence.