Peripheral nerve regeneration, repair, and grafting

Peripheral nerve injuries are a major source of chronic disability. Advances in microsurgery and a better understanding of nerve healing have greatly improved the outcomes of nerve repair in the past two decades. This paper reviews the current thoughts on peripheral nerve regeneration and repair. Controversial topics such as the timing of nerve repair, new techniques of nerve repair (fibrin glue, lasers, and tubulization), nerve grafting, and the treatment of neuroma are discussed. A general approach to postoperative care is presented and shown to be governed by an understanding of not only nerve healing but tissue healing in general. A summary of current clinical results of upper extremity nerve repairs is given to provide benchmarks of practice for hand therapy units to achieve and supersede.